Necrotizing Soft Tissue Infections

Infect Dis Clin North Am. 2021 Mar;35(1):135-155. doi: 10.1016/j.idc.2020.10.004. Epub 2020 Dec 7.


Necrotizing soft tissue infections occur after traumatic injuries, minor skin lesions, nonpenetrating injuries, natural childbirth, and in postsurgical and immunocompromised patients. Infections can be severe, rapidly progressive, and life threatening. Survivors often endure multiple surgeries and prolonged hospitalization and rehabilitation. Despite subtle nuances that may distinguish one entity from another, clinical approaches to diagnosis and treatment are highly similar. This review describes the clinical and laboratory features of necrotizing soft tissue infections and addresses recommended diagnostic and treatment modalities. It discusses the impact of delays in surgical debridement, antibiotic use, and resuscitation on mortality, and summarizes key pathogenic mechanisms.

Keywords: Clostridium; Gas gangrene; Group A streptococcus; Myonecrosis; Necrotizing fasciitis; Necrotizing soft tissue infection; Polymicrobial infection.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Clostridium / isolation & purification
  • Coinfection / microbiology
  • Combined Modality Therapy
  • Debridement / methods
  • Fasciitis, Necrotizing / diagnosis*
  • Fasciitis, Necrotizing / microbiology
  • Fasciitis, Necrotizing / therapy*
  • Female
  • Gas Gangrene / diagnosis
  • Gas Gangrene / therapy
  • Hospitalization
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Soft Tissue Infections / diagnosis*
  • Soft Tissue Infections / microbiology
  • Soft Tissue Infections / therapy*
  • Streptococcal Infections / diagnosis
  • Streptococcal Infections / therapy
  • Streptococcus pyogenes / isolation & purification
  • Tomography, X-Ray Computed / methods


  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents, Non-Steroidal