Skin & Soft Tissue Sepsis

Infection & Sepsis · ICU Decoded chapter 37 · Locked — free with a referral

By Dr Javed Akhtar · Last reviewed 3 October 2026

Cited to IDSA SSTI 2014 · CDC Vibrio guidance 2024.

Key points

Necrotizing fasciitis: pain out of proportion with bullae/crepitus/systemic toxicity means SURGERY NOW; antibiotics alone fail.
Cover empirically with vancomycin plus pip-tazo or a carbapenem, adding clindamycin (toxin suppression); re-explore at 24–36 h, then daily until no further debridement is needed.
Cellulitis: cefazolin or flucloxacillin; drain a purulent collection and cover MRSA when indicated; mark and track the margins.
Myositis/pyomyositis: MRI, drainage plus anti-staph cover; check CK and compartments.

Investigations

First tests: Urgent surgical examination, Full blood count, Sodium, potassium, bicarbonate, urea and creatinine, Blood lactate, Blood cultures.

Only if indicated: Deep tissue / operative culture, CT / MRI of affected region, Creatine kinase.

Repeat monitoring: Clinical, wound and organ-function reassessment.

Management pathways in this chapter

Approach to Soft Tissue Infections

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The pathway step by step, with its decision points
Treatment orders with doses
Why and when to send each test

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