title: Management and Novel Adjuncts of Necrotizing Soft Tissue Infections.
abstract: Necrotizing soft tissue infections (NSTI) have been recognized for millennia and continue to impose considerable burden on both patient and society in terms of morbidity, death, and the allocation of resources. With improvements in the delivery of critical care, outcomes have improved, although disease-specific therapies are lacking. The basic principles of early diagnosis, of prompt and broad antimicrobial therapy, and of aggressive debridement have remained unchanged. Clearly novel and new therapeutics are needed to combat this persistently lethal disease. This review emphasizes the pillars of NSTI management and then summarizes the contemporary evidence supporting the incorporation of novel adjuncts to the pharmacologic and operative foundations of managing this disease.
authors.affiliation: Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Christine S
authors.initials: CS
authors.lastname: Cocanour
authors.affiliation: Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Phillip
authors.initials: P
authors.lastname: Chang
authors.affiliation: Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Jared M
authors.initials: JM
authors.lastname: Huston
authors.affiliation: Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Adams
authors.affiliation: Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Jose J
authors.initials: JJ
authors.lastname: Diaz
authors.affiliation: Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Wessel
authors.affiliation: Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Bonnie A
authors.initials: BA
authors.lastname: Falcione
authors.affiliation: Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Graciela M
authors.initials: GM
authors.lastname: Bauza
authors.affiliation: Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Raquel A
authors.initials: RA
authors.lastname: Forsythe
authors.affiliation: Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Rosengart
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003646:Debridement; D019115:Fasciitis, Necrotizing / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans
chemical_list: D000890:Anti-Infective Agents
keywords: necrotizing fasciitis; necrotizing soft tissue infection; sepsis