Necrotizing soft-tissue infections (NSTIs) are highly lethal infections that share common features including the presence of necrotic tissue and the need for surgical debridement (among other therapies). The nomenclature of these infections has typically been complicated and often confusing because different terms are used to describe specific types of NSTI based on anatomic location, causative organisms, and other features. The use of the term necrotizing soft-tissue infection is advocated because it groups all of these different categories and helps in establishing a common pathway to diagnosis and management. Advanced NSTIs are relatively easy to recognize based on characteristic local findings as well as severe systemic derangement but are also associated with a high mortality rate. Early diagnosis is a key step to improved clinical outcomes, but it is not always a straightforward task. A high index of suspicion, based on risk factors and clinical presentation, coupled with biochemical, imaging, physiologic, and histopathologic studies can help confirm or rule out the diagnosis of NSTI. Surgical exploration is the ultimate diagnostic (and therapeutic) strategy and must be performed whenever in doubt. Management of NSTI includes early and complete debridement, broad-spectrum antimicrobial therapy, and physiologic and nutritional support. A number of prognostic factors have been identified and a prognostic score developed; these tools may help in selecting patients who may benefit from a more aggressive surgical strategy and/or more novel treatments.

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  • Category: Infectious diseases