- Most patients with pyeomyositis have a normal CK, but necrotizing fasciitis is often associated with an elevated CK!
- IV drug use is a risk factor for pyeomyositis, though usually due to local injection rather than hematogenous seeding
- Wound cultures should only be obtained once a wound has been cleaned and debrided and deep tissue culture is preferable
- While imaging is often obtained, surgical exploration is the only way to definitively diagnose or exclude necrotizing fasciitis, and imaging should not delay surgery if suspicion is high
- If imaging is obtained, non-con CT is fastest and most useful for identifying gas in the tissue, which is a very specific but insensitive finding
- Having an LRINEC score of >6 on admission should prompt urgent surgical evaluation for nec fasc, and the positive predictive value increases as the LRINEC score goes up up
- A recent article showed evidence that the LRINEC score could more effectively risk stratify patients with possible necrotizing fasciitis if more weight was given to the CRP and exam factors, including pain, fever, AKI and tachycardia.
Borschitz T, et al. Improviement of a clinical score for necrotizing fasciitis: “Pain out of proportion” and high CRP level aid the diagnosis. PLoS One 2015 Jul 21;10(7):e0132775.