VanderMeulen H, et al. A 10-Year Review of Necrotizing Fasciitis in the Pediatric Population: Delays to Diagnosis and Management. Clin Pediatr (Phila). 2017 Jun;56(7) :627-633.
“The importance of prompt diagnosis stems from its role in the initiation of therapy. Multiple reports support the association of both timely antibiotic initiation and
timely surgical debridement with reduced morbidity and mortality. [3,9,10] This process begins with proper selection of antibiotic agents. Given the delay associated with
receiving results of tissue and blood cultures, empiric therapy should be started immediately. Our data suggests that while the antibiotics initially prescribed often
covered the causative organism, the majority did not provide protection against worrisome bacteria such as MRSA. We argue that coverage against MRSA is warranted
given that it is contributing to an increasing number of cases in North America. [11,12] While various suggestions have been made in the literature, we recommend a combination of clindamycin, vancomycin, and piperacillin-tazobactam. This affords a broad-spectrum coverage of the organisms most likely to be responsible, including as streptococcal species, staphylococcal species, bacteroides species and gram-negative enterobacteriaceae. ”
Zundel S, et al. Diagnosis and Treatment of Pediatric Necrotizing Fasciitis: A Systematic Review of the Literature. Eur J Pediatr Surg. 2017 Apr;27(2):127-137.
Pediatric necrotizing fasciitis (NF) is a rare but severe, life-threatening infection. Early diagnosis is crucial to reduce morbidity and mortality, but initial symptoms are nonspecific. Little sound data exists on factors aiding clinicians to recognize NF in children. With a systematic literature review, we aimed to better characterize pediatric NF. We focused on triggers, symptoms, and laboratory and microbiological findings and differences between pediatric adult patients.
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Jamal N, Teach SJ. Necrotizing fasciitis. Pediatr Emerg Care. 2011 Dec;27(12):1195-9.
Necrotizing fasciitis (NF) is a rare, rapidly progressive bacterial soft tissue infection with a high risk for morbidity and mortality. Although more common in adults, NF also affects the pediatric population. Many bacterial organisms can cause NF, but group A Streptococcus is the most common monomicrobial cause of disease. Necrotizing fasciitis remains principally a clinical diagnosis, and it is often missed early in its presentation because of the difficulty in differentiating it from more common soft tissue infections. The criterion standard for diagnosis and the mainstay of therapy are surgical debridement. Time to initiation and completion of therapy remains the most important factor in patient outcome, highlighting the importance of early recognition and intervention in this potentially devastating disease.