Necrotising soft tissue infection (necrotising fasciitis)
Pain out of proportion means surgery now. Know the types, why LRINEC and imaging can't rule it out, the empirical regimen with clindamycin or lincomycin for toxin suppression, IVIG in streptococcal toxic shock, and Australian exposures.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Necrotising soft tissue infection spreads along the fascia faster than the skin shows. Mortality is about 20% and rises with every hour surgery is delayed.
- Pain out of proportion to the signs is the clue. Systemic toxicity, rapid spread and anaesthetic or bullous skin follow.
- It's a clinical diagnosis and a surgical emergency. LRINEC, CT and blood tests can support it but can't exclude it.
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Sources
- Therapeutic Guidelines: Antibiotic. Skin and soft tissue infections (necrotising skin and soft tissue infections)AU/NZTherapeutic Guidelines Limited (eTG complete), 2025 to 2026 staged update; guideline-wide changes March 2025 (topic version not verified)
- Criteria for the clinical use of immunoglobulin in Australia (toxic shock syndrome entry; exact condition name not verified)AU/NZNational Blood Authority, online, accessed November 2026
- Stevens DL et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the IDSA. Clin Infect Dis 2014;59:e10-52Infectious Diseases Society of America, 2014 (current; no later update found November 2026)
- Wong CH et al. The LRINEC score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004;32:1535-41Critical Care Medicine, 2004
- Fernando SM et al. Necrotizing soft tissue infection: diagnostic accuracy of physical examination, imaging, and LRINEC score. A systematic review and meta-analysis. Ann Surg 2019;269:58-65Annals of Surgery, 2019
- Madsen MB et al. Immunoglobulin G for patients with necrotising soft tissue infection (INSTINCT): a randomised, blinded, placebo-controlled trial. Intensive Care Med 2017;43:1585-93Intensive Care Medicine, 2017
- Babiker A et al. Effectiveness of adjunctive clindamycin in beta-lactam antibiotic-treated patients with invasive beta-haemolytic streptococcal infections in US hospitals: a retrospective multicentre cohort study. Lancet Infect Dis 2021;21:697-710Lancet Infectious Diseases, 2021
- Last updated
- 14 November 2026
What changed
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