Infection & Sepsis · ICU Decoded chapter 37 · Free in full
Cited to IDSA SSTI 2014.
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-debride q24–48 h until clean.
Cellulitis: cefazolin or flucloxacillin; cover MRSA if purulent or risk factors; mark and track the margins.
Myositis/pyomyositis: MRI, drainage plus anti-staph cover; check CK and compartments.
Pathways
Approach to Soft Tissue Infections
Definite signs/symptoms of necrotizing infection?
Explore operatively with possible debridement
WBC >15,400, failure to respond to antibiotics, or signs/symptoms suggesting necrosis?
Soft tissue gas on imaging?
Explore operatively with possible debridement
MRI shows inflammation or enhancement of deep tissues?
Explore locally to inspect fascia and obtain culture → positive: operative exploration with possible debridement
Antimicrobials with close observation
Give antimicrobial therapy with close observation
Did antimicrobial therapy with close observation succeed?
Nothing further needed
Explore locally to inspect fascia and obtain culture → positive: operative exploration with possible debridement; negative: rethink antimicrobial coverage
ICU Decoded — original critical-care and internal-medicine pathways by
Dr Javed Akhtar, each cited to a current guideline. For education and quick
reference; verify every dose against local protocols before prescribing.