ImportanceNecrotizing soft tissue infections (NSTIs) are severe life- and limb-threatening infections with high rates of morbidity and mortality. Unfortunately, there has been minimal improvement in outcomes over time.ObservationsNSTIs are characterized by their heterogeneity in microbiology, risk factors, and anatomical involvement. They often present with nonspecific symptoms, leading to a high rate of delayed diagnosis. Laboratory values and imaging help increase suspicion for NSTI, though ultimately, the diagnosis is clinical. Surgical exploration is warranted when there is high suspicion for NSTI, even if the diagnosis is uncertain. Thus, it is acceptable to have a certain rate of negative exploration. Immediate empirical broad-spectrum antibiotics, further tailored based on tissue culture results, are essential and should be continued at least until surgical debridement is complete and the patient shows signs of clinical improvement. Additional research is needed to determine optimal antibiotic duration. Early surgical debridement is crucial for improved outcomes and should be performed as soon as possible, ideally within 6 hours of presentation. Subsequent debridements should be performed every 12 to 24 hours until the patient is showing signs of clinical improvement and there is no additional necrotic tissue within the wound. There are insufficient data to support the routine use of adjunct treatments such as hyperbaric oxygen therapy and intravenous immunoglobulin. However, clinicians should be aware of multiple ongoing efforts to develop more robust diagnostic and treatment strategies.Conclusions and RelevanceGiven the poor outcomes associated with NSTIs, a review of clinically relevant evidence and guidelines is warranted. This review discusses diagnostic and treatment approaches to NSTI while highlighting future directions and promising developments in NSTI management.

中文翻译：

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坏死性软组织感染


重要性坏死性软组织感染 （NSTIs） 是严重的危及生命和肢体的感染，发病率和死亡率很高。不幸的是，随着时间的推移，结果几乎没有改善。观察NSTI 的特征是它们在微生物学、风险因素和解剖学参与方面的异质性。他们通常表现为非特异性症状，导致高延迟诊断率。实验室检查结果和影像学检查有助于增加对 NSTI 的怀疑，但最终诊断是临床诊断。当高度怀疑 NSTI 时，即使诊断不确定，也需要手术探查。因此，有一定的负面探索率是可以接受的。立即经验性使用广谱抗生素，根据组织培养结果进一步调整，是必不可少的，至少应持续到手术清创完成且患者出现临床改善迹象。需要更多的研究来确定最佳抗生素持续时间。早期手术清创术对于改善结局至关重要，应尽快进行，最好在就诊后 6 小时内进行。随后的清创术应每 12 至 24 小时进行一次，直到患者出现临床改善的迹象，并且伤口内没有额外的坏死组织。没有足够的数据支持常规使用辅助治疗，例如高压氧治疗和静脉注射免疫球蛋白。然而，临床医生应该意识到为制定更稳健的诊断和治疗策略而进行的多项工作。结论和相关性鉴于与 NSTI 相关的不良结局，有必要对临床相关证据和指南进行综述。 本综述讨论了 NSTI 的诊断和治疗方法，同时强调了 NSTI 管理的未来方向和有希望的发展。