Diagnosis-necrotizing soft-tissue infections

• Clinical dx is sufficient to initiate urgent surgical exploration
• Aspiration of necrotic center; BCx; Gram stain; lactate, AST, & CK for deep tissue necrosis
• Imaging: noncontrast CT, but do not delay Rx/surgery (Arch Surg 2010;145:452)
• Microbiologic dx from Gram stain and culture of surgical specimens

LRINEC score: 主要是Lab的參考

• If high suspicion for necrotizing fasciitis through clinical history and physical exam, do not calculate a LRINEC score and go straight to operative debridement.
• Note: Use with caution, as the LRINEC Score has performed poorly in external validation, most recently in Neeki 2017.
• 如果通過臨床病史和physical exam高度懷疑壞死性筋膜炎，則不要計算 LRINEC 評分並直接進行手術清創。
• 項目：C-reactive protein, white blood cell (count), Na, creatinine, Gluose