Necrotizing fasciitis, also known as flesh-eating bacteria, is caused by Streptococcus pyogenes as well as aerobic and anaerobic organisms. Streptococcus pyogenes produces toxins that destroy the skin and its underlying tissue in addition to muscle and fat. Streptococcus pyogenes causes widespread damage to subcutaneous tissue and blocks small vessels under the skin, leading to gangrene and tissue death. Immediate treatment is necessary to stop further damage and attempt to repair the damage that has already occurred.
Antibiotics
Intravenous antibiotics such as penicillin and clindamycin are administered to kill the bacterial infection causing necrotizing fasciitis and to stop the production of toxins that destroy skin tissues. Clindamycin is used for the treatment of skin and soft tissue staphylococcal infections as well aerobic and anaerobic streptococci infections. It inhibits bacterial growth by prohibiting the formation of bacterial proteins. Penicillin has bactericidal properties, interfering with the formation of the bacterial cell wall and ultimately forcing the bacteria to release autolysins that will destroy the bacteria. Broad-spectrum beta lactam antibiotics such as imipenem are administered in addition to penicillin and clindamycin because they kills aerobic bacteria, including those belonging in the Pseudomonas species.
Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy provides high levels of oxygen to promote healing, control infection and reduce the need for surgical debridement. A research study evaluating the mortality rate of individuals receiving hyperbaric oxygen in addition to surgical debridement and antibiotics was published in the November 1990 issue of the journal "Surgery." The study was conducted using two groups: one group of 12 patients who received only surgical debridement and antibiotics as opposed to a second group of 17 patients receiving hyperbaric oxygen therapy in addition to surgery and antibiotics. The study was conducted from 1980 to 1988 and, at the end of the study, individuals receiving hyperbaric oxygen therapy had a significantly lower level of mortality at 23 percent as compared to the first group of patients, who had a 66 percent mortality rate.
Surgical Debridement
Early diagnosis of necrotizing fasciitis is paramount in the treatment of the disease. Since necrotizing fasciitis results in tissue death, surgical debridement is required to remove the infected dead tissue. This surgical removal of dead tissue helps to reduce the number of bacteria in the body, contain the spread of infection and consequently the toxins produced and released by the bacteria. Skin grafts may be necessary to replace tissue removed through debridement. In extreme cases, amputation of an affected limb may be necessary to prevent the spread of the infection to the rest of the body.
