Table Necrotizing soft tissue infections — major clinical entities
| Predisposing factors | Microbiology | Dominant features | Management | |
|---|---|---|---|---|
| Necrotizing fasciitis type I (polymicrobial) | Surgery, trauma, diabetes mellitus | Anaerobes, Gram-negative aerobic bacilli | Necrosis of fat and fascia, may have gas | Debridement, broad-spectrum antibiotics, ITU support |
| Necrotizing fasciitis type II (group A streptococcal) | Surgery, minor trauma, varicella | Streptococcus pyogenes | Rapidly progressing necrosis of multiple tissue layers, no gas, shock | Debridement, penicillin & clindamycin, ITU support |
| Clostridial myonecrosis (gas gangrene) | Trauma, surgery, spontaneous (cancer) | Clostridial species | Fulminant myonecrosis, prominent gas formation | Debridement, penicillin & clindamycin, ITU support, hyperbaric oxygen |
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ITU support = intensive treatment unit support (ie, fluids, ventilation, inotropic drugs, nutrition)
