Necrotising Fasciitis / Fournier's Gangrene

Clinical features

• Rapidly progressive (over minutes) soft tissue infection at any site
• May result from seemingly minor trauma or skin break
• Severe swelling and pain
• Haemodynamic instability
• High fever
• This is a life-threatening emergency and requires rapid escalation
• Most patients will require HDU / ICU level care

Investigations

• Blood culture
• Theatre samples – tissue and fluid obtained at debridement

Infection Control

Isolate with contact precautions

Treatment

This is a SURGICAL EMERGENCY. Contact the on-call general surgical team IMMEDIATELY, then give antibiotics – urgent debridement is the primary intervention required

For Fournier’s gangrene (necrotising fasciitis involving the genitals) contact the on-call UROLOGIST

PIPERACILLIN-TAZOBACTAM and MEROPENEM are unrestricted for this indication

PIPERACILLIN-TAZOBACTAM IV 4.5g 6 hourly 

PLUS

CLINDAMYCIN IV 1.2g 6 hourly

If true penicillin allergy:

MEROPENEM IV 1g 8 hourly 

PLUS

CLINDAMYCIN IV 1.2g 6 hourly

Ongoing antibiotic therapy and duration of treatment should be discussed with Microbiology