Necrotizing Soft Tissue Infections (NSTI)

Abstract

Necrotizing soft tissue infections (NSTI) are a rare condition characterized by rapid but subtle onset of spreading inflammation and necrosis starting from the fascia, involving muscles and subcutaneous fat, with subsequent necrosis of the overlying skin. Irrespective of its etiology, both polymicrobial and monomicrobial, this pathology warrants an aggressive multidisciplinary strategy, encompassing broad-spectrum antibiotic therapy, extensive surgical debridement, critical care, and postsurgery hyperbaric oxygen therapy (HBO), in order to limit the spread of systemic inflammatory response and to reduce mortality. This chapter provides an extensive overview of the microbiology, pathophysiology, and diagnostic and therapeutic strategies to be considered in case of necrotizing soft tissue infections. The clinical scenario at the end of the chapter helps the reader to practically apply in a real setting all the suggested diagnostic and therapeutic tricks. This is an updated, easy-to-use work of reference for all clinicians, residents, and caregivers who may be involved in the management of patients suffering from NSTI.