Consensus on the Diagnosis and Treatment of Adult Necrotizing Fasciitis
A 2024 expert consensus published in the Chinese Medical Journal provides comprehensive guidance on the diagnosis and treatment of adult necrotizing fasciitis (NF), a rapidly progressive soft tissue infection with high mortality. The statement, developed by leading Chinese clinicians, aims to improve early recognition and standardize treatment protocols across medical centers.
Consensus Highlights:
- Clinical Recognition: NF should be suspected in patients with rapidly worsening pain, skin discoloration, bullae, and systemic toxicity—especially when pain is disproportionate to exam findings.
- Laboratory and Imaging Clues: Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, elevated CRP, and CT/MRI can support early diagnosis, but clinical judgment remains paramount.
- Surgical Emergency: Early, aggressive surgical debridement is emphasized as the most critical component of treatment. Repeated exploration may be required.
- Antibiotic Therapy: Broad-spectrum intravenous antibiotics should be started promptly. Recommended regimens include carbapenems or beta-lactam/beta-lactamase inhibitor combinations, with coverage for MRSA and anaerobes as indicated.
- Supportive and Adjunctive Measures: Hemodynamic stabilization, organ support, nutritional support, and optionally hyperbaric oxygen therapy are addressed as key components of a multidisciplinary approach.
Conclusion: The consensus provides standardized criteria for early recognition and coordinated management of necrotizing fasciitis. Timely diagnosis, surgical debridement, and appropriate supportive care are essential to reducing mortality in this severe infection.
Keywords: necrotizing fasciitis, LRINEC score, surgical debridement, broad-spectrum antibiotics, Chinese Medical Journal, hyperbaric oxygen