Necrotising fasciitis: a narrative review of the literature

Br J Hosp Med (Lond). 2021 Apr 2;82(4):1-9. doi: 10.12968/hmed.2020.0577. Epub 2021 Apr 21.

Abstract

Necrotising fasciitis is a severe, life-threatening and rapidly progressive soft tissue infection that often requires aggressive surgical management, with an estimated incidence of about 0.24-0.40 per 100 000 in the UK. Necrotising fasciitis can be classified based on its microbiology or the anatomy or body region affected. Initial signs of necrotising fasciitis can be minimal and non-specific but a patient often presents with pain out of proportion to clinical signs on examination, as well as erythema and oedema, in addition to systemic symptoms associated with sepsis. Diagnosis is often based on high clinical suspicion with biochemical and clinical imaging used as adjuncts. To aid with early diagnosis of necrotising fasciitis, a scoring system known as the Laboratory Risk Indicator for necrotising fasciitis was developed which has a positive predictive value of 92%. Once diagnosed, appropriate resuscitation and antibiotics, along with prompt and aggressive surgical debridement, is the mainstay of treatment.

Keywords: Broad spectrum antibiotics; Debridement; Laboratory Risk Indicator for necrotising fasciitis; Necrotising fasciitis; Resuscitation, Skin infection.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Debridement
  • Early Diagnosis
  • Fasciitis, Necrotizing* / drug therapy
  • Fasciitis, Necrotizing* / therapy
  • Humans
  • Risk Factors
  • Soft Tissue Infections*

Substances

  • Anti-Bacterial Agents