Table Necrotizing soft tissue infections — major clinical entities

Predisposing factorsMicrobiologyDominant featuresManagement
Necrotizing fasciitis type I (polymicrobial)Surgery, trauma, diabetes mellitusAnaerobes, Gram-negative aerobic bacilliNecrosis of fat and fascia, may have gasDebridement, 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, shockDebridement, penicillin & clindamycin, ITU support
Clostridial myonecrosis (gas gangrene)Trauma, surgery, spontaneous (cancer)Clostridial speciesFulminant myonecrosis, prominent gas formationDebridement, penicillin & clindamycin, ITU support, hyperbaric oxygen
  • ITU support = intensive treatment unit support (ie, fluids, ventilation, inotropic drugs, nutrition)