Necrotizing Soft Tissue Infections

Diabetics are more susceptible to skin and soft tissue infections, and in current studies, up to half of patients who develop necrotizing soft tissue infection have diabetes. Patients typically present with acute, severe illness and prominent skin findings. However, a percentage of patients with necrotizing soft tissue infection will be difficult to delineate from cellulitis. Laboratory and radiographic scoring systems have been proposed to aid in the diagnosis of necrotizing soft tissue infections, but surgical evaluation remains the definitive means of diagnosis. Aggressive emergent surgical debridement is essential to reduce morbidity and mortality and should be coupled with broad empiric antibiotic therapy. When diabetics present with soft tissue infection, physicians should consider the possibility of underlying necrotizing infection and pursue surgical evaluation if there are signs of systemic illness, characteristic skin findings, failure to respond to antibiotics, or characteristic radiographic findings.