Necrotizing soft-tissue infections survival guide in adult patients: A position statement by the Global Alliance for Infections in Surgery

ABSTRACT: Necrotizing soft-tissue infections (NSTIs) are acute, rapidly progressive infections of soft tissues, often associated with signs of severe systemic toxicity and progressive multi-organ failure. This rapid, often fatal progression of local disease mandates timely diagnosis. Delays in diagnosis and treatment may have dire consequences. Effective treatment includes appropriate debridement associated with directed antibiotic therapy and hemodynamic support. Early surgical debridement with complete removal of necrotic tissue, including potential amputation, is essential to decrease mortality and other complications. The initial treatment of patients with NSTIs requires collaboration between surgeons, intensivists, and infectious disease specialists. Extensive tissue debridements may create challenges for wound care, preservation of function, reconstruction, and cosmesis, requiring ongoing multidisciplinary collaboration. This evidence-based position statement has been signed by a representative multidisciplinary working group of experts, with its main objective being to describe best practices for the first-line management of NSTIs in adult patients.