Martinschek et al reported prognostic factors for patients with necrotizing soft tissue infections (NSTI). These can help to identify a patient who may benefit from more aggressive management. The authors are from the Federal Armed Forces Hospital of Ulm, Germany.
Patient selection: necrotizing soft tissue infection (with or without necrosis of muscle; with systemic progression and need for intensive care)
Conditions associated with worse survival:
(1) diabetes mellitus
(2) heart failure
(3) sepsis at presentation
(4) abdominal wall involvement
(5) hemodynamic instability
(6) elevated serum CK
(7) elevated serum lactate
Cornerstones of management:
(1) early diagnosis and aggressive therapy
(2) immediate adequate surgical debridement
(3) intravenous antibiotic therapy
(4) intensive care
(5) hyperbaric oxygen, especially with Clostridia infections
