title: Management of necrotizing skin and soft tissue infections.
abstract: Although rare, necrotizing skin and soft tissue infections can be devastating infections that are difficult to diagnose and challenging to manage. Clinical presentation is often insidious, and a low index of suspicion is critical. Various diagnostic tools, such as scoring systems or imaging techniques, have been introduced, but none is convincingly superior to sound clinical judgment. Early diagnosis allows early adequate therapy that includes antibiotic therapy, critical care support, specific interventions such as intravenous immunoglobulin in selected patients and, most importantly, early source control. Empirical antibiotic therapy should cover a broad range of both Gram-negative and Gram-positive aerobic and anaerobic microorganisms, and clindamycin is recommended when group A Streptococcus is a suspected pathogen.
authors.affiliation: Department of Critical Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium. jan.dewaele@ugent.be
authors.forename: Jan J
authors.initials: JJ
authors.lastname: De Waele
mesh_terms: D061605:Administration, Intravenous; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002981:Clindamycin / Q000008:administration & dosage / Q000627:therapeutic use; D042241:Early Diagnosis; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000473:pathology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D009336:Necrosis; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents; D016756:Immunoglobulins, Intravenous; D002981:Clindamycin