Treating necrotizing skin and soft-tissue infections

Abstract

Among skin and soft-tissue infections, necrotizing skin and soft-tissue infections (NSTIs) are by far the most frequent and the most severe cases admitted to the intensive care unit (ICU). Timely and adequate surgical and medical care are the only modifiable features in their management [1]. The heterogeneity of patients, including varying comorbidities, clinical presentations, causative microbes and treatments, requires a team approach involving multidisciplinary management [2,3]. Early diagnosisTypical cases are usually readily identified on clinical grounds, leading to early emergency admission and source control. In contrast, underestimation of the burden of comorbidities, slow onset or atypical symptoms without sepsis, are common risk factors for delayed diagnosis, and late adequate care. Immunocompromised patients are at particular risk and should be considered severe cases [3,4]. NSTIs can affect any part of the body, most commonly the extremities, pelvix and cervix [4,5]. Initial misdiagnosis, admission of these patients to a nonacute care surgery service, or interhospital transfer to tertiary centers before source control represent the most common reasons for belated surgical management.