Necrotizing Soft-Tissue Infections: Clinical Guidelines

... ... ... The purpose of these guidelines is to examine existing data regarding the diagnosis and treatment of NSTIs and to provide an evidence-based and reasoned approach to the care of patients with NSTI. These guidelines target both physicians involved in the initial diagnosis and management of NSTI and specialists involved in the definitive treatment— including debridement and coverage procedures—of patients with NSTI. NSTIs are rare but potentially fatal infections involving the skin, subcutaneous tissues, and muscle. Because of accompanying systemic illness and profound inflammatory response, these patients are typically critically ill and have prolonged intensive care unit stays. In addition, these patients have large, complex wounds and are often treated in specialized treatment centers such as burn units.1,2 A PubMed literature search was performed for topics relating to NSTIs including pathology, genetics, diagnosis, treatment options, outcomes, antibiotic therapy, plasma exchange, burn centers, HBO, wound coverage, and nutrition. References were classified as Class I evidence (prospective, randomized, controlled trials); as Class II evidence (prospective or retrospective studies based on clearly reliable data); as Class III evidence (clinical series, comparative studies, case reviews or reports); or as Technology Assessment (a study that examined the utility/reliability of a particular technology).