Necrotising fasciitis Immediate surgical opinion is essential

BMJ 1994;309:341-342 (30 July)

Letters

Necrotising fasciitis Immediate surgical opinion is essential

EDITOR, - Three aspects of necrotising fasciitis mentioned inTimothy S Burge and James D Watson's editorial require furtherclarification.¹ Firstly, the key to the successful managementof necrotising fasciitis is the immediate referral for surgicalopinion of patients with atypical cellulitis.² Only with earlyrecognition of the possible diagnosis can the established guidelinesof prompt resuscitation, diagnostic incision, and radical debridementbe instigated, thereby improving the prospects of survival.

Secondly, the bacteriology of necrotising fasciitis is unclearbecause multiple organisms are usually isolated³ and the clinicalpresentation does not differ according to the presence or absenceof streptococci.⁴ In a series of 14 patients group H streptococciwere present in only three.² Escherichia coli (10 patients),Bacteroides fragilis (seven), and Streptococcus faecalis (five)were the organisms cultured most commonly.² The initial useof broad spectrum antibiotics, including penicillin, as an adjunctto aggressive surgery is therefore appropriate.