5 Things You Should Know About Necrotizing Soft Tissue Infection

Necrotizing soft tissue infection (NSTI) is a disease that has a rapid course and is associated with sepsis and multisystemic organ failure. It is important to know that the mortality rates range from 20% to 30%. Moreover, a delay in surgical debridement of more than 24h has been associated with increased mortality. Therefore, prompt diagnosis is of utmost importance. In other words, the cornerstone of NSTI treatment is early diagnosis, aggressive and successful treatment, and appropriate antibiotics.

Usually, the disease is polymicrobial or caused by Group A streptococci. The bacteria produce toxins and spread rapidly through the fascia. Several risk factors for developing NSTI have been identified, such as alcoholism, diabetes mellitus, intravenous drug use or immunosuppression. The classic symptoms are: significant pain (what is known as a “pain out of proportion”), erythema, edema, fever, hemorrhagic bullae, hypotension, and even shock. It is common to diagnose based on patient risk factors and physical examination, together with imaging techniques. However, a high-quality systematic review and meta-analysis have shown that real evidence regarding diagnosis is scarce. Meta-analysis could be performed only for such symptoms as fever, hemorrhagic bullae, and hypotension, and it was found that the sensitivity scores of these signs were low-moderate. It is therefore suggested that high-risk patients should undergo further tests or surgical consultation even in the absence of fever, hemorrhagic bullae and hypotension. On the other hand, diagnostic can also rely on imaging, especially X-rays and CT scan. It is a common practice to ask for a CT scan when there are diagnostic doubts, but surgical consultation and debridement should never be delayed in cases of systemic compromise.

This talk focuses on the most important things that any surgeon should know about NSTI. High-quality studies published in important journals have also been analyzed, in order the provide the best knowledge in a manner that is easily applicable.