No time to waste when treating necrotizing fasciitis

It was just another day working in your garden, until you scraped your leg. In just a few hours it was red and swollen, and you had a fever. You knew this was no ordinary reaction to a cut and it was time to get to the emergency room. Fortunately the doctor who examined you was quick to suspect necrotizing fasciitis, a rare bacterial infection sometimes referred to as “flesh-eating bacteria.”

Washington University physician John Kirby, MD, specializes in wound healing and acute and critical care surgery. He explains, “Necrotizing fasciitis is an unusual bacterial infection that usually starts with a wound or scrape and quickly worsens – it is a red or swollen area that spreads rapidly, accompanied with severe pain and fever. One day a person can be perfectly healthy, and the next day he or she is critically ill in the emergency room.

When we see a patient in the ER, if we suspect necrotizing fasciitis, time is of the essence. Aggressive antibiotic treatment and prompt surgery are the first steps in stopping this deadly infection.”

Symptoms can develop quickly and the infection will spread rapidly. Later symptoms can include:

  • Ulcers, blisters or black spots on the skin
  • Changes in the color of the skin
  • Pus or oozing from the infected area
  • Feeling sick or even confused 

Serious complications are common such as sepsis, shock, and organ failure. Because antibiotics may not reach all of the infected areas (due to reduced blood flow in the damaged or dead tissue), the tissue would need to be surgically removed to stop the infection from spreading. Sometimes this means amputating a leg or arm. Even with treatment, one in three people with necrotizing fasciitis die from the infection.

 Dr. Kirby advises, “The cases we see in this region are usually due to soil contamination from someone working in the garden or falling off a motorcycle. If if you have an open wound, it is always best to avoid hot tubs, swimming pools and salt or lake bodies of water.

Being proactive with common sense wound care is important. Always clean all minor cuts and injuries that break the skin. See a doctor for puncture and serious wounds and think about tetanus prophylaxis.”

Bridging long distances for treatment and the best outcome

Because Barnes-Jewish Hospital and Washington University Physicians cover a large geographic region for patient care, a patient showing signs of necrotizing fasciitis might live two or three hours away from St. Louis.  The first option for medical treatment may be with an individual practitioner in a small town. That physician might not feel comfortable in making the decision that amputation is needed to save the patient’s life.  

Dr. Kirby adds, “The problem then becomes how we can start treatment to save this patient’s life who is two or three hours away. Ideally, an outreach program to partner with local doctors is the answer. With good guidelines, a physician could begin treatment by debriding (removing necrotic or dead tissue) the wound, leaving the wound open and immediately transporting the patient to us for further treatment that could include further surgery, antibiotics, and negative pressure wound therapy.

If amputation is eventually needed at a later point in time, the patient would have the peace-of-mind knowing that everything was done to save his or her limb. And perhaps with better initial treatment, we would decrease the rates of amputation.”

To make an appointment with Dr. Kirby or reach one of his partners, please call 314-362-5298. For emergencies, please contact the ACCS on call surgeon through the Doctor’s Access Line at 800-252-3627.

Barnes-Jewish Center for Outpatient Health
4901 Forest Park Avenue, 3rd floor
St. Louis, MO 63108