Category: Critical Care
Keywords: Necrotizing Soft Tissue Infections, sepsis, critical care, surgery (PubMed Search)
(Sorry for the previously mislabeled pearl...)
Necrotizing soft tissue infections (NSTI) are on the rise and, despite improved surgical and critical care, over the years there has only been a mild reduction in mortality. Survival is associated with early diagnosis and treatment. Unfortunately, NSTI are not always obvious because deeper tissues made be involved first. Despite a validated scoring system and better radiology, our clinical suspicion still rules and relies on a meticulous history and physical exam.
Here are some subtle signs of NSTI:
Pain out of proportion to exam
Edema beyond region of erythema
Skin erythema and/or hyperthermia
If NSTI is suspected, be vigilant! Start broad-spectrum antibiotics, begin appropriate resuscitation and involve your surgeons early.
Necrotizing soft tissue infections in the intensive care unit. Crit Care Med. 2010 Sep; 38: S460-8. Phan HH, et al.