Diagnostic methods: Lab tests, biopsy, x-rays
Laboratory testing for necrotizing fasciitis is thought by most experts to be non-specific. Another investigative team found that 76% of patients with necrotizing soft-tissue infections had low platelet count or PT and PTT with higher than normal values; prolonged PT is associated with increase mortality.6 Hypocalcemia, hypoproteinemia, anemia, and acidosis have also been noted.
Diagnosis must be considered early when necrotizing fasciitis is suspected. Although the gold standard for diagnosis is biopsy or wound exploration and surgical debridement,6 diagnosis can be made early when necrotizing fasciitis is suspected.
The role of soft-tissue radiographs in the diagnosis of necrotizing fasciitis is unclear. Plain films can provide information such as soft-tissue thickening and internal gas formation. Unfortunately, plain radiographs typically show no specific abnormality until the necrotizing process is well advanced.
Treatment of necrotizing fasciitis
Resuscitation
Adequate fluid resuscitation and stabilization of any patient suspected of having necrotizing fasciitis is the first line of therapy. Large-bore IV lines or a central line may be necessary. Adequate monitoring should include a Foley catheter and pulse oximetry. Correction of any metabolic abnormalities needs to be addressed.
Antibiotics
Antibiotic treatment should be started as soon as possible, although no study has shown antibiotics to significantly alter mortality. A Gram stain of the infected material would be helpful to guide further antibiotic choices. However, initial therapy should be directed at both aerobic and anaerobic organisms.