Necrotizing fasciitis: Pathogenesis and treatment

Necrotizing fascilitis is a rapidly progressive, life-threatening infection and a true infectious disease emergency. Despite much clinical experience, the management of this disease remains suboptimal, with mortality rates remaining approximately 30%. Necrotizing fascilitis rarely presents with obvious signs and symptoms and delays in diagnosis enhance mortality. Therefore, successful patient care depends on the physician's acumen and index of suspicion. Prompt surgical debridement, intravenous antibiotics, fluid and electrolyte management, and analgesia are mainstays of therapy. Adjunctive clindamycin, hyperbaric oxygen therapy and intravenous immunoglobulin are frequently employed in the treatment of necrotizing fascilitis, but their efficacy has not been rigorously established. Improved understanding of the pathogenesis of necrotizing fascilitis has revealed new targets for rationally designed therapies to improve morbidity and mortality.