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Invited Critique
February 1, 2005

Predictors of Mortality and Limb Loss in Necrotizing Soft Tissue Infections—Invited Critique

Arch Surg. 2005;140(2):158. doi:10.1001/archsurg.140.2.158

The mortality of necrotizing soft tissue infections has declined to 20% or less. Surgeons have made important contributions to disease management by establishing the principles of early recognition, adequate resuscitation, initiation of broad-spectrum antibiotics, and prompt debridement. No doubt, advances in diagnostic testing (computed tomography and magnetic resonance imaging) and the use of repeated operative debridement for source control,1 as advocated in this study, contribute to the improved results. The mortality of these infections also depends on the presence of comorbid diseases, bacterial virulence (particularly, Streptococcus pyogenes and clostridia), and the genetically programmed response to severe infection.