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Necrotizing soft tissue infections

Adam M Shiroff1, Georg N Herlitz, Vicente H Gracias

  • 1Division of Acute Care Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

Journal of Intensive Care Medicine
|June 12, 2013
PubMed

Insights

Necrotising soft tissue infection (NSTI) requires a high index of suspicion for early diagnosis and management. Prompt surgical exploration and aggressive debridement are crucial for successful outcomes in patients with this aggressive infection.

Area of Science:

  • Infectious Diseases
  • Surgical Pathology
  • Critical Care Medicine

Background:

  • Necrotising soft tissue infection (NSTI) presents diagnostic and management challenges.
  • Understanding NSTI subtypes (Type I and Type II) is crucial for patient stratification.
  • Pathophysiology involves microbial factors leading to rapid tissue destruction and sepsis.

Purpose of the Study:

  • To highlight the diagnostic challenges and management strategies for NSTI.
  • To differentiate between NSTI types based on patient demographics and microbial etiology.
  • To emphasize the importance of early surgical intervention and multidisciplinary care.

Main Methods:

  • Clinical presentation analysis of NSTI types.
  • Review of pathophysiology including superantigen activity and pus viscosity.
  • Evaluation of diagnostic tools like physical examination and the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score.
  • Emphasis on surgical exploration and debridement.

Main Results:

  • Type I NSTI: older, less healthy patients, trunk, polymicrobial. Type II NSTI: younger, healthier patients, extremities, trauma history, monomicrobial.
  • Tenderness beyond redness is a key finding; absence of crepitus is not reassuring.
  • LRINEC score shows potential for excluding suspected NSTI cases.
  • Early surgical exploration and debridement are vital.

Conclusions:

  • Early recognition and surgical exploration are paramount for managing NSTI.
  • Aggressive serial debridement and multidisciplinary critical care are essential for improving patient outcomes.
  • While LRINEC shows promise, clinical suspicion should guide management decisions.
Keywords:
Necrotising soft tissue infectionsuperantigen

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