Necrotizing soft tissue infections.

Necrotizing soft tissue infections (NSTIs) are aggressive severe soft tissue infection that cause rapid and widespread infection and necrosis of the skin and soft tissues and are highly lethal. NSTIs include necrotizing cellulitis, adipositis, fasciitis and myositis/myonecrosis and have significant potential for extensive soft tissue and limb loss. Early diagnosis and treatment of NSTIs remains the cornerstone of therapy. Timely aggressive surgical debridement and early appropriate antibiotic treatment are required for a successful outcome and clinical cure. Mortality rate has decreased from 25-50% in past years, to 10-16% in recent years with aggressive surgical and medical management. Additional innovative strategies for the treatment of NSTIs, including intravenous immuno-globulin G (IVIG), hyperbaric oxygen, and vacuum-assisted closure, do not yet have definitive evidence of efficacy, but may be considered in patients at high risk of death. A comprehensive knowledge of the pathophysiology, diagnostic features, causative microbial pathogens, and treatment strategies (including surgical debridement and antimicrobial therapy) is required for successful management of NSTIs.