57 - Necrotizing soft tissue and skin infections

Summary

This chapter discusses the diagnosis, evaluation and management of necrotizing soft tissue and skin infections (NSTIs). NSTIs are notoriously difficult to diagnose early in the disease course, with initial signs and symptoms usually typical of cellulitis. As the NSTI progresses, patients may present with ecchymoses, bullae, and crepitus as a result of subcutaneous emphysema. It is common to see signs of systemic toxicity with NSTIs versus soft tissue infections without necrotizing component. When a patient with NSTI deteriorates suddenly, the etiology is likely to be sepsis and septic shock. Early goal-directed therapy should be initiated immediately with additional nursing and physician staff is mobilized to assist with the effort if all of these interventions should ideally take place within minutes of the patient being evaluated and nothing should be prioritized over early and adequate surgical intervention. Norepinephrine is the first-line vasopressor in these patients when they present in septic shock.