(Canada--Canadian Family Physician, July 2000, p. 1460.) The incidence of necrotizing fasciitis caused by Group A streptococcal infection may be increasing, but the condition is still extremely rare. Fewer than two cases per 100,000 persons were reported in one Norwegian study. Approximately 71 percent of cases in a study in Canada occurred in patients with chronic illnesses such as renal failure, diabetes and alcoholism. Local skin trauma is implicated in about one half of all cases. Other risk factors include male gender, increased age and winter months. The mortality rate is at least 5 percent in patients with necrotizing fasciitis alone, but the rate increases with age, hypotension, bacteremia and the use of nonsteroidal anti-inflammatory drugs. Successful management of necrotizing fasciitis depends on early surgical debridement, high-dose intravenous antibiotics (i.e., penicillin G and clindamycin) plus supportive therapy. Hyperbaric oxygen and intravenous immune globulin therapies have also been tried experimentally.
COPYRIGHT 2001 American Academy of Family Physicians
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