What data is needed today to deal with cellulitis and necrotizing fasciitis?

Cellulitis and necrotizing fasciitis can be distinguished by the depth of t he cutaneous lesion and classically by the different bacteria implicated. T his classification is not taken into account by the practitioner because of a similar therapeutic strategy. That is why most authors used a single tit le: necrotizing soft tissue infection. The potential severity of these infe ctions required a quick diagnosis to decrease the risk of mortality and sev ere functional consequences. The analysis of the literature doesn't allow t o establish the incidence of these infections. It was demonstrated that inf ections due to Streptococcus serogroup A increased over the last few years, thanks to a specific surveillance system. Risk factors leading to these in fections are: cutaneous trauma, age, diabetes, varicella in children, conta ct with people infected by Streptococcus. The most recent studies demonstra ted a frequent polymicrobism of the infections, with anaerobes, Streptococc us, Staphylococcus, and gram-negative rods. At the onset of the disease, th e diagnosis is difficult to establish. Pain, induration of tissues, a rapid evolution, the inefficacy of antibiotic treatment suggest the diagnosis of necrotizing infection. MRI, when available, is a good technique to reveal the depth of the infection and necrosis. Surgery will confirm the diagnosis and allow for debridement of necrotized tissues. A delayed surgery increas es the mortality risk factor, as stated in numerous studies.