Necrotizing Soft Tissue Infections: A Review

Necrotizing soft tissue infections (NSTIs) are severe, life-threatening infections of skin, fascia and muscle that feature high morbidity and mortality. They require rapid diagnosis, multidisciplinary care, and aggressive treatment. They can be polymicrobial (Type 1) or monomicrobial (Type 2) and caused by pathogens including Group A Streptococcus, Staphylococcus aureus, Clostridium, Aeromonas, and Vibrio vulnificus. Diagnosis relies on early clinical suspicion, serial examinations, imaging studies, and selected scoring systems. Early surgical exploration and debridement are the most important interventions, significantly reducing mortality when performed promptly. Treatment also requires broad-spectrum antimicrobial therapy with appropriate narrowing when possible, intensive supportive care, and selected adjunctive measures. Despite advances in management, NSTIs remain associated with substantial mortality, moribidity, amputation risk, disability, and long-term psychological consequences.