Suspected Necrotizing SSTI

Clinical Features Suggesting Necrotizing SSTI

  • Pain out of proportion to clinical findings

  • Rapid progression

  • Gas in tissues/crepitus (on exam or imaging)

  • Overlying tissue necrosis

  • Reduced sensation over affected area

  • Severe sepsis/septic shock

Notes

Obtain blood cultures x 2 sets and CK level in addition to other routine labs.

Imaging does not rule out the diagnosis of a necrotizing infection.

If suspected necrotizing fasciitis, need deep tissue specimen for C&S.

Surgical debridement is critical in cases of necrotizing fasciitis.

Most Likely Pathogens

Clinically one cannot reliably distinguish between necrotizing cellulitis, fasciitis, or myonecrosis.

Polymicrobial infection involving Gram positive and Gram negative aerobes plus anaerobes

Monomicrobial infection involving Group A Streptococcus (Streptococcus pyogenes) and less often, Staphylococcus aureus.