[17, 18]. According to this, the incidence of these infections is rising because of an increase in the number of immunocompromised patients, diabetes, cancer, alcoholism, vascular insufficiencies click here and organ transplants. Almost half of these infections are idiopathic, because we are not able to identify any underlying lesion at the site of the NSTI [7]. The best examples of such cases are scrotal

or penile NF. Causative organisms are numerous and often may be polymicrobial (Table 3) [18, 19]. There is no age or sex predilection for infection [18]. Because of the Lazertinib accompanying systemic illness and profound tissue inflammation, these patients are usually critically Rigosertib concentration ill and have prolonged ICU stay. They need critical care therapy and complex surgical management, and can be treated in a specialized facility such as a burn center or a burn unit [7]. Laboratory based scoring systems as LRINEC score test (The Laboratory Risk Indicator for Necrotizing Fasciitis) [20] (Table 3.) or APACHE II score test (The Acute Physiology and Chronic Health Evaluation) may help in the early diagnosis of NF [21]. Both scoring tests are not NSTI specific, but are accurate predictors of mortality rates

in most NF cases. Pathophysiology and microbiological findings According to the updated consensus for NSTIs (1,2), microbial invasion of skin and

subcutaneous tissue occurs either through external trauma and surgical wounds, or directly through bacterial invasion from a perforated viscus. Table 4 present potential antibiotic therapeutic regimens however for certain pathogenic organisms and predisposing factors. Microorganisms appearing in the skin and subcutaneous tissue spaces produce various endo- and exotoxins that cause prolonged vasoconstriction in the dermal capillary network. When these toxins are released into the systemic circulation, they produce the SIRS, which can progress into septic shock, MODS and finally, death [1, 2, 14]. The central pathohistological point in the pathogenesis of NSTIs is the thrombosis of perforating vessels of the skin and subcutis [17]. As the spread and extent of infection do not correspond with overlying skin changes, an inexperienced surgeon might not clearly determine the seriousness and extent of infection that takes place under the skin surfaces and in the subcutaneous space. In case of fulminating NF, MODS will develop within the first 24 hours of infection. In this case the disease will very often become fatal if not promptly recognized and treated with extensive surgical debridement, appropriate a combination of the antibiotics, and intensive care resuscitation [21].