[Necrotizing skin and soft tissue infections: definitions, clinical and microbiological features].
Among the three types of soft tissue and skins infections (cellulitis, necrotising cellulitis and necrotising fasciitis) only the necrotising injuries are commonly managed in intensive care unit. Location, depth and severity of these potentially life threatening infections may vary and cannot be predicted on clinical grounds No microbiological deduction can be made from clinical signs. A mixed aerobic-anaerobic flora is cultured in 40 to 80% of the cases. Magnetic resonance imaging and CT-scan are the best techniques to assess the diagnosis and determine the extension of infection. However, these exams should not delay surgical treatment. Fifteen to 30% of the patients die. Three parameters play a key role in the prognosis: ability of the physician to recognise the disease and to evaluate the severity of infection, early onset of antimicrobial therapy, and most of all early surgical debridement.
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Unité de réanimation chirurgicale, département d'anesthésie-réanimation, CHU Hôtel-Dieu, université Paris-V, place du Parvis-Notre-Dame, 75004 Paris, France. remy.gauzit@htd.ap-hop-paris.fr