Hospital-Acquired Flesh-Eating Necrotizing Fasciitis

One of the infections that may be acquired while in the hospital is necrotizing fasciitis, known by its more common name, flesh-eating bacteria, or the flesh-eating disease. Necrotizing fasciitis is a fast-spreading bacterial skin infection that kills the body's soft tissue. While healthy people with normal immune systems are rarely at risk of developing necrotizing fasciitis in their day-to-day lives, hospitalized patients are at greater risk of contracting the disease.

Necrotizing fasciitis can be caused by several different kinds of bacteria, including group AStreptococcus (group A strep), Klebsiella, Clostridium, Escherichia coli, Staphylococcus aureus, and Aeromonas hydrophila. Group A strep is the most common bacteria that causes the disease, but experts believe necrotizing fasciitis caused by methicillin-resistant Staphylococcus aureus (MRSA) is becoming more common.

The disease develops when bacteria spread after entering the body, often through a break in the skin, like a cut, scrape, burn, insect bite, or puncture wound. The bacteria infects flat layers of fascia, connective bands of tissue that surround muscles, nerves, fat, and blood vessels. Toxins released by the bacteria kill the fascia and surrounding tissues.

The bacteria can spread rapidly through the body (sepsis) and needs to be treated quickly. Many patients suffer permanent scarring and may even require amputation of a limb. About 25% of the patients who are infected with necrotizing fasciitis will die from the infection. According to the Centers for Disease Control and Prevention, 700-1200 Americans are infected with necrotizing fasciitis each year.

Most hospital cases of necrotizing fasciitis occur in patients who have open wounds, in particular, those who have either had surgery or have been hospitalized due to an injury-causing accident. Because of the nature of the infection, necrotizing fasciitis is not a hospital infection that patients can do much to control except to be sure that the wounds stay clean.

To keep a wound clean requires strict adherence to sanitary precautions, including frequent handwashing. It is also recommended that any hospital personnel with open wounds or cuts themselves, or respiratory illness, should not make contact with patients with open wounds to avoid infecting those wounds.

Any patient who will be in the hospital for surgery or any open wound should protect themselves by taking steps to prevent a hospital-acquired infection.

Necrotizing fasciitis symptoms usually appear within hours of an injury or wound, and are often vague and resemble those of other illnesses. Symptoms include:

• Pain or soreness, similar to that of a "pulled muscle"
• Warmth and redness or purplish areas of swelling that spread quickly
• Ulcers, blisters or black spots on the skin
• Fever, chills, fatigue or vomiting may follow the initial wound or soreness

Patients with necrotizing fasciitis require treatment with very strong antibiotics administered through a needle into a vein. However, even the strongest antibiotics may not reach all of the infected areas because of the soft tissue damage and reduced blood flow caused by the bacterial toxins. Because of this, in some cases, physicians will often perform surgical exploration and debridement, removal of dead tissue, as well.