Decision
H&P consistent with necrotizing infection? (See background section below)
Yes
- Obtain surgical consult
- Administer IV antibiotics
- Keep patient NPO
(Class I)
Background
Is the H&P consistent with necrotizing infection ?
“Most common signs of NSTI are nonspecific (swelling, pain, erythema) and are also present in benign infections. Not a single “classic” identifier for NSTI (bullae, crepitus, necrosis) was found in more than half of the patients diagnosed with NSTI and, when present, they were often found later in the disease progression.”
Imaging
- Computed tomography (CT) sensitivity 88.5% and specificity 93.3%
- Plain films sensitivity 48.9% and specificity 94.0%
Neither can be relied upon to confidently exclude the diagnosis of NSTI.
- Presence of gas is often used to confirm NSTI; however, not all NSTIs are type I polymicrobial gas-forming infections.
- In the absence of gas, other findings such as fascial thickening and hyperemia are nonspecific and can be found in other disease processes.
- Available literature indicates that imaging can be supportive of a diagnosis, but if there remains a high clinical suspicion for NSTI despite negative imaging results, treatment and urgent surgical consultation should still take place.
Prevalence of Signs and Symptoms in Necrotizing Soft-Tissue Infections
- Swelling (80.8%)
- Pain or tenderness (79%)
- Erythema (70.7%)
- Fever >37.5°C (40%)
- Bullae (25.6%)
- Skin necrosis (24.1%)
- Crepitus (20.3%)
Cellulitis