Necrotizing Fasciitis

Necrotizing fasciitis or other necrotizing soft tissue infection 

Diagnosis is supported by signs of systemic toxicity with toxic-shock-like symptoms, severe pain or pain out of proportion to physical findings, altered mental status, rapidly advancing infection, crepitus, hemorrhage, sloughing.

Intraoperative findings include  presence of grayish fascia, lack of resistance of normally adherent muscular fascia to blunt dissection, lack of bleeding of the fascia during dissection and presence of foul-smelling "dishwater" pus

Group A streptococcus 

Can be polymicrobial including anaerobes, Clostridium spp, with skin flora 

Vancomycin  
(follow link for dosing & monitoring) 

AND  

Piperacillin-tazobactam
100 mg piperacillin/kg/dose (max 4000 mg piperacillin/dose) IV q6h  

AND 

Clindamycin
10 mg/kg/dose (max 900 mg/dose) IV q8h  

Penicillin or cephalosporin allergy with higher risk for allergic reaction: 

Consult ID/ASP for guidance on alternative therapy 

Urgent Surgery consult recommended 

ID consult recommended 

Therapy should be modified as indicated based on isolated pathogen(s), including narrowing the initial regimen to target identified pathogen(s) and stopping clindamycin after initial clinical improvement.  

Duration: 7-14 days, guided by response to therapy. Continue until further debridement is not necessary, patient has clinically improved, and is afebrile for 48-72 hours