What is the pathogenesis of necrotizing fasciitis?

Updated: Sep 02, 2020
  • Author: Steven A Schulz, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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During the last 2 decades, researchers have found that necrotizing fasciitis is usually polymicrobial rather than monomicrobial. [35, 36, 37] Anaerobic bacteria are present in most necrotizing soft-tissue infections, usually in combination with aerobic gram-negative organisms. Anaerobic organisms proliferate in an environment of local tissue hypoxia in those patients with trauma, recent surgery, or medical compromise.

Facultative aerobic organisms grow because polymorphonuclear neutrophils (PMNs) exhibit decreased function under hypoxic wound conditions. This growth further lowers the oxidation/reduction potential, enabling more anaerobic proliferation and, thus, accelerating the disease process.

Carbon dioxide and water are the end products of aerobic metabolism. Hydrogen, nitrogen, hydrogen sulfide, and methane are produced from the combination of aerobic and anaerobic bacteria in a soft tissue infection. These gases, except carbon dioxide, accumulate in tissues because of reduced water solubility.

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