Necrotizing soft-tissue infections

Abstract

Necrotizing soft-tissue infections (NSTIs) are a heterogeneous group of life- and limb-threatening infections that can involve the skin, subcutaneous tissues, fascia and/or muscle. NSTIs can be classified according to their clinical appearance, tissue level, and/or microbiological composition. Most patients affected with NSTI suffer from chronic debilitating diseases and/or are immune-compromised. Clinical signs of NSTI are unspecific in the initial phase. Severe pain disproportional to the clinical appearance is a leading factor in the diagnosis of NSTI. Without treatment, these infections rapidly progress, leading to septic-toxic shock syndrome and multiple organ failure in an early stage. Only radical surgical treatment, including amputations, high-dose triple antibiotics, and life support may prevent a fatal outcome. Hyperbaric treatment may have a positive effect, however, extensive reconstructive plastic surgery after recovery is needed to repair the soft-tissue defects. Mortality for NSTI is 35 % for limb-affected patients and 100 % for trunk-affected patients. Clinical awareness at the onset of these infections may prevent serious complications or death.