Evaluation and Management of Necrotizing Soft Tissue Infections

Abstract

Despite advances in antibiotic and surgical management and supportive care for necrotizing soft tissue infections, morbidity and mortality remain substantial. Although there are clinical practice guidelines in place, there still remains much variability in choice and duration of antibiotic therapy, time to initial surgical debridement, and use of adjuvant medical therapies. This article offers an overview of necrotizing soft tissue infections with a focus on current diagnostic and treatment modalities.

Keywords: Gangrene; Necrotizing fasciitis; Sepsis; Soft tissue infection.

Figure 1

Vicious cycle of necrotizing soft tissue infection

Figure 2

a Evidence of Gas tracking on the fascia on X ray in a patients with NSTI involving the leg. [Used with permission]: Chaudhry A, Baker K, Gould E, Gupta R. Necrotizing Fasciitis and it’s mimics: What Radiologists need to know. AJR 2015; 204: 128–139. b Subcutaneous emphysema on X ray in a patient with NSTI of the thigh. [Used with permission] from Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing Fasciitis: Current Concepts and Review of the Literature. JACS 2009; 208(2): 279–288.

Figure 2

a Evidence of Gas tracking on the fascia on X ray in a patients with NSTI involving the leg. [Used with permission]: Chaudhry A, Baker K, Gould E, Gupta R. Necrotizing Fasciitis and it’s mimics: What Radiologists need to know. AJR 2015; 204: 128–139. b Subcutaneous emphysema on X ray in a patient with NSTI of the thigh. [Used with permission] from Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing Fasciitis: Current Concepts and Review of the Literature. JACS 2009; 208(2): 279–288.

Figure 3

CT scan of a patient with necrotizing soft tissue infection, demonstrating edema in the soft tissues and air tracking along the fascia planes. [Used with permission] : Chaudhry A, Baker K, Gould E, Gupta R. Necrotizing Fasciitis and it’s mimics: What Radiologists need to know. AJR 2015; 204: 128–139.

Figure 4

MRI findings for a patient with necrotizing fasciitis and myositis, demonstrating increased T2-weighted soft tissue enhancement and gas in the soft tissues. [Used with permission:]

Figure 5

Management pathway in NSTI. [Used with permission]. Original source: Morgan MS. Diagnosis and management of necrotising fasciitis: a multiparametric approach. J Hosp Infect 2010;75:249–57.