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Pathogens
Antimicrobials
Suggested Antimicrobial Regimen
Obtain blood cultures and CK with other labs.
Imaging does not rule out the diagnosis of a necrotizing infection.
Ensure tissue sent for culture and STAT gram stain if going to OR.
Clinically one cannot reliably distinguish between necrotizing cellulitis, fasciitis, or myonecrosis (intraoperative diagnosis).
Necrotizing fasciitis type I
Polymicrobial infection involving aerobes and anaerobes
Necrotizing fasciitis type II
Monomicrobial infection involving Group A Streptococcus, sometimes S. aureus.
Necrotizing cellulitis
May be caused by Clostridial species contaminating existing wound (especially traumatic), or by gram negatives, other anaerobes.
Necrotizing myositis
typically Group A Streptococcus or other beta-hemolytic streptococci.
