Chapter 14 - Necrotizing Soft Tissue Infections

Abstract

Necrotizing soft tissue infections (NSTIs) represent life-threatening events that require aggressive surgical intervention, systemic antibiotic therapy, and effective supportive management. NSTIs are a heterogeneous group which may be caused by Clostridium perfringens, Streptococcus pyogenes, Staphylococcus aureus, or by a polymicrobial microflora of gram-positive, gram-negative, and anaerobic bacteria. Virtually all bacterial species and even fungal organisms are associated with NSTI. They are locally aggressive infections that may involve only the skin and subcutaneous tissue, or they may encompass extensive necrosis of skeletal muscle. External evidence of the extensive nature of NSTI may be subtle early in the disease, and requires the clinician to have a high index of suspicion when patients have a rapidly increasing soft tissue inflammatory process associated with a systemic inflammatory response. The hallmark feature of NSTIs is the presence of increasing pain and tenderness that is disproportionate to the apparent cutaneous injury or infection.