What Is Necrotising Fasciitis (Necrtotizing Fasciitis)
Whereas you might have heard a lot about MRSA and C Difficile as common hospital superbugs, Necrotising Fasciitis is another less known superbug yet equally or even more hostile. It is also known as the 'Flesh Eating Superbug' and is a bacteria which attacks the soft tissue and a sheath of tissue covering the muscle (the fascia). A tiny scratch can be enough for the bacteria to enter your skin and to start to earn the rather unpleasant yet accurate 'nickname'.
How Does The Necrotising Fasciitis Bacteria Enter?
The flesh eating superbug can enter your skin due to a small cut or abrasion, or through direct contact with the bacteria from another carrier of it (e.g. another patient in hospital)
Development Of The Condition
Once the bacteria has entered the body it quickly reproduces and destroys the soft tissue and fascia which then dies. It is essential that the dead (gangrenous) tissue is surgically removed to save the life of the patient. The bacteria can cause unbearable pain, very low blood pressure, confusion, fever and severe dehydration. Whilst thankfully necrotising fasciitis is a rare condition it is also difficult to diagnose which can cause severe problems because a failure to diagnose and treat swiftly will result in death of the patient.
If the condition is left untreated it will eventually cause the body's organs to go into systemic shock. This can result in respiratory failure, heart failure, low blood pressure and renal failure. Basically, every system of the body can fail.
Failure To Diagnose Necrotising Fasciitis
Many cases of Necrotizing Fasciitis are misdiagnosed because at the beginning symptoms look like a minor affliction. It is often the case that until a patient is so ill that they are at the critical stage that the medical profession does not consider Necrotizing Fasciitis. There is more chance of the condition being diagnosed in an accident and emergency department rather than at a GP surgery or a walk-in or out-of-hours service. However, even in accident and emergency departments, patients are diagnosed with other conditions, for example constipation if the affected area is in the buttock, meaning that the patient is left untreated with death being the eventual outcome.
Treatment Of Necrotising Fasciitis
It must be treated in a hospital with antibiotic intravenous therapy and aggressive removal of the affected tissue (known as debridement). For those patients who do survive there is usually some removal of the skin required which often requires skin grafting by a plastic surgeon. Amputation is sometimes needed to remove affected limbs.
Prevention Of The Bacteria
Simple methods such as good hand washing can prevent the spread of the infection, and ensuring the skin is intact will also prevent it from entering the patient. If a patient does suffer a wound that pierces the skin this should be cleaned and monitored closely for signs of infection (such as redness, swelling, drainage and pain).
Treatment
The treatment is a combination of surgical debridement, antibiotics and optimal oxygen. Early diagnosis is of critical importance to prevent radical surgery or death.
An accident and emergency department will normally transfer a patient to a surgical team based on a high index of suspicion of necrotising fasciitis. Aggressive surgical debridement (removal of infected tissue) is always necessary to keep it from spreading. Diagnosis is made by visual examination of the tissues and by tissue samples sent for microscopic evaluation. If there is a high index of suspicion of necrotising fasciitis antibiotics should be started immediately. Initial treatment will include a combination of intravenous antibiotics including penicillin, vancomycin and clindamycin. Cultures are then taken to decide an overall appropriate antibiotic coverage and the initial intravenous antibiotics then may be changed.
As with other conditions characterised by tissue destruction, hyperbaric oxygen treatment can be a valuable therapy and can assist in reducing mortality and the rate of infection. However, it is not always widely available. Amputation of affected organs may therefore be necessary and repeat surgical procedures are usually needed to remove additional necrotic tissue. This often leaves a large open wound which will require skin grafting. Most patients will be monitored in an intensive care unit after surgery.
Summary
Necrotising Fasciitis is clearly a dangerous bacteria. If diagnosed and treated early the patient should make a full recovery. However, if a hospital fails to notice the signs and symptoms and the condition is allowed to deteriorate it can lead to serious and even life threatening conditions. If this happens it can lead to a claim for medical negligence compensation.
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