Impact of clinical interventions in the timely diagnosis and therapeutic approach of necrotizing soft tissue infections

Abstract

Necrotizing soft tissue infections (NSTIs) are a group of clinical entities characterized by progressive and fulminant destruction of rapidly evolving tissues, associated to high mortality rates due to systemic toxicity and multiorgan failure.1 The microbiological classification of NSTIs by subtypes is very useful to review therapeutic and diagnostic schemes. Type 1 is the most prevalent, comprising polymicrobial infections by aerobic and anaerobic bacteria. The predominant isolates are species of the Streptococcus, Staphylococcus, Enterococcus, Pseudomonas, Acinetobacter, Bacteriodes generas and members of the Enterobacteriacea family. Clostridium commonly participates in this context without causing myonecrosis. Events that compromise peripheral vascularization are the classic risk factor for acquiring the infection, where interestingly, no triggering events where identified in 20-50% of patients.2 The Fournier Gangrene, diabetic foot infection and necrotizing fasciitis are classic infections of this group. It also includes complications of odontogenic infections caused by Fusobaterium, Peptostreptococcus, Bacteriodes, anaerobic Streptococcus and spirochetes.1–2 Type 2 NSTIs are monomicrobial caused by Streptococcus group A, some are accompanied by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). Unlike the first group, these infections can occur in patients without predisposing factors.1–2