Monitoring
Patients need to be monitored for lack of response to therapy. This most often occurs when there is a need for additional, more extensive debridement. Less commonly, lack of response may be due to either antimicrobial resistance or incorrect antibiotic agent selection.
Monitoring for decline in respiratory/hemodynamic function is essential, with consideration of possible toxic shock in patients with group A streptococcal infection.
Consider the need for additional debridement or alteration in antibiotic or antifungal therapy, based on culture results from subcutaneous tissue or blood, the patient’s clinical condition, and discussion with the multidisciplinary team.[43]
Surgical re-exploration to assess the need for further debridement should be performed at least every 12-24 hours after the initial debridement.[2]
However, re-exploration may be needed sooner in some patients; inform the surgical team urgently if the patient has clinical signs of worsening infection (local or systemic), or worsening imaging markers (particularly white blood cell count).[2]
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