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Necrotising Fasciitis - A Bacterial Infection

Necrotising fasciitis is a bacterial infection. It happens when certain bacteria travel to the deep tissues of the body. In this article we take a closer look at the bacterial infection necrotising fasciitis.

Necrotising fasciitis

Necrotising fasciitis (or necrotizing fasciitis) is pronounced 'neck-ro-tize-ing fas-e-i-tis. The word 'necrotising' means that cells in the body have died due to illness, injury or a lack of blood supply. 'Fasciitis' is when the fascia (bands of connective tissue inside the body) become inflamed. Therefore necrotising fasciitis is essentially when underlying tissues - primarily the fascia - become inflamed and die.

Necrotising fasciitis bacterial infection

Necrotising fasciitis is a bacterial infection. It occurs when certain bacteria reach the body's deep tissues and begin to reproduce. The process of reproduction does two things: firstly, it releases a chemical into the body that destroys the nearby tissue and blood vessels. Secondly, it creates more infective bacteria, who then go on to reproduce, causing the infection to spread very rapidly.

As a consequence of these two things, the patient's tissue will quickly break down and die. The damage done to the surrounding tissue and blood vessels mean that blood will not be able to reach the tissues. The tissue cannot survive without blood, because this is how oxygen reaches the cells. Without blood and oxygen, the cells will die - or in medical terms, will become necrotic.

Because of the rapid reproduction process, the infection will begin in one local site but will then spread across more and more tissue. This means that the extent of tissue death will grow very quickly. It can take just days from the point of infection to widespread tissue death.

How does the bacteria get into the body in the first place?

For the necrotising fasciitis infection to occur, the bacteria must first get into the body and travel to the deep tissues. Normally the bacteria will enter through a gap in the skin. The skin acts as a natural defence mechanism against foreign bodies. But it is possible for bacteria to enter through a wound (such as a surgical wound), a cut (such as a graze) or a natural opening (such as the eye).

What bacteria cause the necrotising fasciitis infection?

There are many different types of bacteria, and certain bacteria cause certain infections. So what causes the necrotising fasciitis infection? There are in fact a number of potential bacteria that can lead to a necrotising fasciitis infection. The most common is Group A Streptococcus (GAS). This is the same bacteria that causes minor illness such as a sore - or 'strep' - throat. But the effect is entirely different when the bacteria invades the body and reaches the deep tissues.

The other types of bacteria that can result in a necrotising fasciitis infection include Klebsiella, Clostridium, Escherichia coli (E.coli), Staphylococcus aureus and Aeromonas hydrophilia.

Identifying the bacteria

When someone develops necrotising fasciitis, it is important to identify which type of bacteria is causing the infection. This can be done by sending a swab to the laboratory for testing.

This process can take over a day, which is a long time when someone has necrotising fasciitis because they need immediate treatment. Therefore while the tests are being done, the patient should be put on broad-spectrum antibiotics. This medicine should be administered intravenously. Broad-spectrum antibiotics works against a range of bacteria and are useful when medical practitioners are uncertain of the exact cause.

When the type of bacteria has been established, the treatment can be refined as doctors will know what antibiotic works best against that particular bacteria.

Getting rid of the infection

However, antibiotics alone will not rid the body of infection. Surgical debridement is also needed, where the infected tissue is removed. This is a vital element of the treatment because without it the infection will remain inside the body. Often more than one debridement operation is needed to completely eliminate the bacteria. Sometimes this surgery will actually involve an entire amputation of a food, hand or limb.

What will happen without treatment?

Without treatment, the patient will almost certainly die. One study of necrotising fasciitis found that without treatment there was a 100% mortality rate. This statistic appears terrifying, but it is important to note that a patient can recover from necrotising fasciitis as long as the correct treatment is provided - and this treatment is carried out in time.

As mentioned above, necrotising fasciitis must be treated with surgical debridement and antibiotics. What is also essential is that this treatment is given shortly after the infection occurs. Every case is different, but a patient can become critically ill within a day or two of the bacteria first entering the body.

The patient will become critically ill because the bacteria will spread throughout the tissue, and will soon end up in the bloodstream. Once in the bloodstream the bacteria will travel around the body, triggering a potentially fatal condition called sepsis. Sepsis is when the body tries to fight off an infection but attacks its own organs and tissues in the process. This is very dangerous and is responsible for around 31,000 deaths in the UK every year.

Doctors did not realise I had necrotising fasciitis

As bacterial infections go, necrotising fasciitis is very rare. Nevertheless, it does cause symptoms that are characteristic of a bacterial infection. These include skin that is red and hot to touch, inflammation, fever and severe pain.

These are key signs of a tissue infection, and they should be recognised as such by any reasonably competent medical practitioner. Realising that a patient has some form of bacterial infection is half the battle and should lead to a timely diagnosis of necrotising fasciitis being made.

A failure to investigate a possible bacterial infection with urgency represents a substandard level of care. If this happened to you or your loved one, you might be wondering whether there is a case of medical negligence.

Expert legal advice

To find out if you can make a medical negligence claims for necrotising fasciitis, please get in touch with us today for a free initial enquiry with a legal expert.

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