Suspected Necrotizing SSTI
Clinical Features Suggesting Necrotizing SSTI
Pain out of proportion to clinical findings
Gas in tissues/crepitus (on exam or imaging)
Overlying tissue necrosis
Reduced sensation over affected area
Severe sepsis/septic shock
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.