Necrotizing Fasiitis

8/17/2019 Necrotizing Fasiitis

1/30

N E C

R O T I Z

I N G

F A S

I I T I S


2/30


3/30

OUTLINE

Defnition

Risk actors

Classifcation

Pathophysiology

Symptoms

Investigations

Treatment


4/30

WHAT IS NECROTIZING FASCIITIS?

It is a progressive, rapidly spreading, inammatoryinection located in the deep ascia with secondarynecrosis o the s!ctaneos tisse""

inection rapidly destroy the skin and sot tisse

!eneath it#lso known as$ “esh%eating” !acteria"

&ther names$ '%hemolytic streptococcal gangrene,(eleney lcer, acte dermal gangrene, hospitalgangrene, and necroti)ing celllitis"

* types o +"Type I : a polymicrobial fora.

Type II Grop A !"S#r$p#ococc% bac#$ria &mo%# commo'ca%$(

Type III : mari'$ )ibrio *ram"'$*a#i)$ ro+%.


5/30

T,-E I NECROTIZING FASCIITIS

(i-ed aero!ic and anaero!ic inection

.acteria almost always isolated

S" ares, Streptococci, /nterococci, /"coli, Peptostreptococcs spp,Prevotella, Porphyromonas, ." ragilis,and Clostridim spp"

(ore common in dia!etics, post op pt,and pt with peripheral vasclar disease"


6/30

• C$r)ical '$cro#ii'* /a%cii#i%

L+0i*1% a'*i'a &L+0i*2% a'*i'a i% a' i'/$c#io' o/ #3$foor o/ #3$ mo#3 '+$r #3$ #o'*$. I# i% +$ #o

bac#$ria(• For'i$r1% *a'*r$'$

Ca%$+ by p$'$#ra#io' o/ #3$ GI or r$#3ral mco%a by$'#$ric or*a'i%m%

/or'i$r2% *a'*r$'$: A 3orr$'+o% i'/$c#io' o/ #3$ *$'i#alia

#3a# ca%$% %$)$r$ pai' i' #3$ *$'i#al ar$a &i' #3$ p$'i%a'+ %cro#m or p$ri'$m( a'+ pro*r$%%$% /rom $ry#3$ma&r$+'$%%( #o '$cro%i% &+$a#3( o/ #i%%$.Ga'*r$'$ ca' occr0i#3i' 3or%. T3$ mor#ali#y &+$a#3( ra#$% ar$ p #o 567


7/30

T,-E II NECROTIZING FASCIITIS

(onomicro!ial

Grop A S#r$p 8RSA & m$#3icilli' r$%i%#a'# %#ap3ylococc% ar$% (

Can occr in any age grop and in healthy patients

Risk actors H9o bl'# #rama or lac$ra#io' aric$lla I';$c#io' +r* %$ -o%# op -o%# par#m


8/30


9/30

T,-E III

Type * % 0ram%negative monomicro!ial inection$

This incldes marine organisms sch as 1i!riospp" and #eromonas hydrophila, which canoccr ollowing seawater contamination owonds, in2ries involving fsh fns or stings,and raw seaood consmption % particlarly in

patients with chronic liver disease"

These marine inections are particlarly virlentand can !e atal within 34 hors"


10/30


11/30

RIS> FACTOR

Immnocompression illnesses

e"g"$ D(, Cancer, alcoholism, vasclarins5ciency, organ transplant, 6I1 ornetropenia"

Trama or oreign !odies in srgical wond"

Idiopathic as scrotal or penile necroti)ingasciitis"


12/30

-ATHO-H,SIOLOG,

.acteria eat away at tisse !etween skin andmscle

Increase in sensitivity or anaesthetic eel to theskin itsel

Inammatory response !y immne system

.acterial to-ins released e-oto-in #Cytokines impede nction o phagocytic cells A'a$rob$% #3ri)$ %p$$+i'* p '$cro#ic proc$%%

/ndothelial cells !ecome damaged7 I'cr$a%$+ p$rm$abili#y o/ #3$ li'i'* o/ )$%%$l% i' #3$

bo+yPoor !lood spply inhi!it$ I'famma#ory r$%po'%$ proc$%% Abili#y /or #3$ imm'$ %y%#$m #o prop$rly 0or Abili#y #o #ra'%/$r a'#ibio#ic% #o #3$ a@$c#$+ /a%cial lay$r

1asoconstriction and throm!osis edema h o-ia necrosis o the ascia skin sot


13/30

S8(PT&(S

Compari'* #3$ 'i'/$c#$+ %i' #o #3$ $arly a'+ a+)a'c$+/orm% o/ #3$ +i%$a%$:

Normal %i' Early %#a*$ A+)a'c$+ %#a*$


14/30


15/30


16/30

CRITICAL S,8-TO8SThe critical symptoms orm in the

last stages o +"*:< o patient=s develop

hemorrhagic !llae which maycase them to !ecome anemic"

1asclatre o the skin !ecomesinamed and throm!osed"Reslting in necrotic eschars

that look like deep thermal!rns"

>ithot treatment, secondaryinvolvement o deeper msclelayers may occr"

Patients may !ecome nm!

!ecase o nerve damage andprogressing gangrene in theinected area"

?nconsciosness will occr as the!ody !ecomes too weak tofght o@ the inection alongwith a severe decrease in thepatient=s !lood pressre"

#s to-ins are !eing released, the=


17/30

EBA8S AN= LA


18/30

INESTIGATIONS

Imaging Stdies$

%ray

gas in the s!ctaneosascia planes"

D"D" o s!ctaneos gas in a

radiograph"

C"T" demonstrating necrosis with

asymmetric ascial thickening E gas in the tisses"

(RI scans may help to show the e-tent o tisse involvement!t may not !e accrate and shold not delay srgery"

?ltrasond has also !een sed to show s!ctaneos gas" F93G

http://patient.info/doctor/necrotising-fasciitis-pro#ref-14http://patient.info/doctor/necrotising-fasciitis-pro#ref-14


19/30


20/30

INESTIGATION

Comptedtomography

demonstratessot tisse gascollection rom aninvasive 0rop #

Streptococci.acteria"

Gas

vesicles

Gas

vesicles


21/30


22/30

TREAT8ENT

/arly and aggressive srgical e-ploration andde!ridement

R$$plora#io' %3ol+ b$ p$r/orm$+ 09i' D 3r%

#nti!iotic therapy

Typ$ I: ampicilli' or 'a%y' 0i#3 cli'+amyci' or fa*yl I/ r$c$'# 3o%pi#alia#io' %$ o%y' or #im$'#i' i'%#$a+ o/ 'a%y'.

Typ$ II: -CN G a'+ cli'+amyci' )a'comyci'

6emodynamic spport

Intravenos immnoglo!lin Hcrrently nder

investigation, !t not recommended6yper!aric o-ygen therapy


23/30


24/30

Cetria-one HRocephin

Cetria-one is the drg o choice in initial treatment" It is athird%generation cephalosporin with !road%spectrm, gram%negative activity" It has lower e5cacy against gram%positive

organisms and higher e5cacy against resistant organisms" Itarrests !acterial growth !y !inding to one or more penicillin%!inding proteins"

0entamicin

0entamicin is an aminoglycoside anti!iotic or gram%negativecoverage" It is sed in com!ination with !oth an agent againstgram%positive organisms and one that covers anaero!es" It isnot the drg o choice, !t shold !e considered i penicillinsor other less to-ic drgs are contraindicated, when clinicallyindicated, and in mi-ed inections cased !y sscepti!lestaphylococci and gram%negative organisms"

#d2st the dose !ased on creatinine clearance HCrCl andchanges in volme o distri!tion" ollow each regimen !y atleast a trogh level drawn on the third or orth dose H:" h!eore dosing" Peak level may !e drawn :" h ater a *:%mininsion


25/30

Chloramphenicol

Chloramphenicol !inds to : S !acterial%ri!osomals!nits and inhi!its !acterial growth !y inhi!iting

protein synthesis" It is e@ective against gram%negativeand gram%positive !acteria"

#mpicillin

#mpicillin has !actericidal activity against sscepti!leorganisms" It is an alternative to amo-icillin when the

patient is na!le to take medication orally" It may !eadded to the initial regimen i the 0ram stain sggeststhat enterococci are present"

Imipenem and cilastatin HPrima-in

This com!ination is sed or treatment o inectionsde to mltiple organisms in which other agents donot have wide%spectrm coverage or arecontraindicated !ecase o potential or to-icity"


26/30

#mpicillin and sl!actam H?nasyn

This com!ination o ampicillin and a !eta%

lactamase inhi!itor covers skin, enteric ora,and anaero!es" It is not ideal or treatment onosocomial pathogens"

1ancomycin H1ancocin

1ancomycin is an anti!iotic directed againstgram%positive organisms and active against/nterococcs species" It is sel in thetreatment o septicemia and skin%strctreinections" 1ancomycin is indicated or

patients who cannot take or whose conditionsail to respond to penicillins andcephalosporins or those with inections withresistant staphylococci"

To prevent to-icity, the crrent


27/30

H,-ER


28/30

-REENTION

(ost people are in goodhealth !eore they !ecomeinected"

Degrees to lessen yorchances

ba%ic 3y*i$'ic prac#ic$% &0a%3i'*3a'+%(

$$p all 0o'+% cl$a'

0a#c3 /or %i*'% o/ i'/$c#io' &i'cr$a%$pai' %0$lli'* p% 3$a# or /$)$r(

%$$ imm$+ia#$ m$+ical a##$'#io' i/3a)$ %ymp#om% o/ f$%3"$a#i'*

+i%$a%$ a'+

3a)$ pr$ca#io' i/ i' clo%$ co'#ac#

0i#3 %om$o'$ 0i#3 #3$ bac#$ria.


29/30

-ICTURES


30/30

Documents

Necrotizing Fasiitis