RARE DISEASE
Necrotizing soft tissue infection
Necrotizing soft tissue infection
Necrotizing soft tissue infection
Synonyms: NSTI
Synonyms: NSTI
Synonyms: NSTI
Drug discovery
2
drugs
With orphan designations
Overview
Necrotizing soft tissue infection (NSTI) is a rapidly progressive, life-threatening bacterial or fungal infection causing tissue necrosis, systemic toxicity, and high mortality (6–76%) [1][4][7]. It primarily affects subcutaneous fat, fascia, or muscle, often arising from polymicrobial (70–80%) or monomicrobial (β-hemolytic streptococci, S. aureus) pathogens [1][3][10]. Diagnosis requires prompt surgical exploration due to nonspecific early symptoms (e.g., disproportionate pain, erythema) [6][16].
Categories: rare infectious diseases
Research Papers
989 drug discovery papers about Necrotizing soft tissue infection, with 3 first-in-class emerging drug candidates forecasted to outperform the average preclinical success rate. Recent publications:
989 drug discovery papers about Necrotizing soft tissue infection, with 3 first-in-class emerging drug candidates forecasted to outperform the average preclinical success rate. Recent publications:
2026-07-08 | Neorectal Perforation and Necrotizing Soft Tissue Infection of the Lower Limb Following Pelvic Reirradiation for Recurrent Rectal Cancer: A Case Report.
Neorectal perforation is a rare but serious complication following treatment for rectal cancer, and may lead to catastrophic sequelae if diagnosis and management are delayed. We report the case of a 54-year-old woman with locally recurrent rectal cancer who developed neorectal perforation and necrotizing soft tissue infection of the lower limb following chemoradiotherapy. Initial symptoms were attributed to sciatic nerve inflammation, and surgical consultation was delayed. The patient subsequently developed septic shock and was found to have extraperitoneal perforation extending through the greater sciatic foramen, with extensive necrotizing fasciitis of the gluteal and thigh compartments. Management required urgent laparotomy with resection of the colonic J pouch, omentoplasty, feeding gastrostomy, and extraperitoneal end colostomy, followed by multiple surgical debridements. The patient experienced prolonged critical illness, including multiorgan failure and colonization of wounds with multidrug-resistant organisms. Successful recovery was achieved through aggressive multidisciplinary care, including novel use of negative pressure wound therapy with acetic acid instillation. This case highlights the need for caution when re-irradiating the neorectum in the presence of a neorectal ulcer, and the importance of early surgical involvement in complex post-treatment complications.
2026-07-02 | Hemipelvectomy for Clostridium septicum necrotizing soft tissue infection with extensive pelvic organ destruction: a case report.
Clostridium septicum is a highly virulent, gas-forming, anaerobic Gram-positive bacillus known to cause rapidly progressive necrotizing soft tissue infection that is often associated with gastrointestinal malignancy or immunocompromised states. Mortality remains extremely high, with many patients dying within the first 24 h of onset. Although aggressive surgical debridement is the cornerstone of treatment, cases requiring hemipelvectomy are exceedingly rare, and postoperative management of exposed pelvic organs has not been described in the relevant literature. A 73-year-old woman with ascending colon cancer developed sudden severe left leg pain and paralysis, and computed tomography revealed extensive gas from the left thigh to the pelvis. Upon arrival at our tertiary center, she was in septic shock with gas rapidly progressing to the high retroperitoneum. Emergent hip disarticulation was performed, and Clostridium septicum was isolated. Despite early source control, ongoing toxin-mediated necrosis extending beyond the limits of limb amputation necessitated left hemipelvectomy on Day 4. Following radical debridement, postoperative management became extremely challenging because multiple pelvic organs were exposed, with necrosis of the bladder and perforation of ureter, rectum and vaginal wall. Serial debridement and staged repairs were required over a prolonged course. Granulation of the pelvic wound gradually progressed, allowing split-thickness skin grafting on Day 88, after which wound healing stabilized. She was ultimately stable enough to return to the referring hospital on Day 187. This is an extremely rare case of Clostridium septicum necrotizing soft tissue infection requiring hemipelvectomy, demonstrating that aggressive and timely radical debridement can be life-saving, even in cases with massive pelvic involvement. Furthermore, we present the first documented example of stepwise management of exposed pelvic organs after hemipelvectomy performed for necrotizing soft tissue infection, providing valuable insights for clinicians facing similar catastrophic presentations.
2026-06-29 | Pedicled Supraclavicular Flap Reconstruction Following Cervicofacial Necrotizing Fasciitis: A Case Report.
Cervicofacial necrotizing fasciitis is a life-threatening surgical emergency associated with significant morbidity and mortality, requiring early diagnosis and aggressive multimodal management. Reconstruction of the resulting soft tissue defects represents an additional challenge, particularly in resource-limited settings where microsurgical infrastructure may not be available. We report the case of a 42-year-old man who developed cervicofacial necrotizing fasciitis secondary to an odontogenic infection. Management consisted of broad-spectrum antibiotic therapy, early surgical debridement, and negative pressure wound therapy as a bridge to reconstruction. Once infection was controlled and a viable granulation tissue bed was established, definitive reconstruction was performed using a pedicled supraclavicular fasciocutaneous flap. The procedure was completed without complications, with satisfactory flap integration, cervicofacial contour restoration, and minimal donor site morbidity documented at outpatient follow-up. The pedicled supraclavicular flap proved to be a safe, reliable, and technically reproducible reconstructive option in this postinfectious context, offering an intrinsic vascular supply independent of the compromised recipient bed, a wide arc of rotation, and excellent color and texture match to cervicofacial skin. Its applicability in settings without microsurgical resources further supports its role as a first-line reconstructive strategy. This case contributes to the limited evidence on supraclavicular flap reconstruction following cervicofacial necrotizing fasciitis and underscores the value of a sequential, protocol-driven approach in achieving favorable outcomes.
2026-07-08 | Neorectal Perforation and Necrotizing Soft Tissue Infection of the Lower Limb Following Pelvic Reirradiation for Recurrent Rectal Cancer: A Case Report.
Neorectal perforation is a rare but serious complication following treatment for rectal cancer, and may lead to catastrophic sequelae if diagnosis and management are delayed. We report the case of a 54-year-old woman with locally recurrent rectal cancer who developed neorectal perforation and necrotizing soft tissue infection of the lower limb following chemoradiotherapy. Initial symptoms were attributed to sciatic nerve inflammation, and surgical consultation was delayed. The patient subsequently developed septic shock and was found to have extraperitoneal perforation extending through the greater sciatic foramen, with extensive necrotizing fasciitis of the gluteal and thigh compartments. Management required urgent laparotomy with resection of the colonic J pouch, omentoplasty, feeding gastrostomy, and extraperitoneal end colostomy, followed by multiple surgical debridements. The patient experienced prolonged critical illness, including multiorgan failure and colonization of wounds with multidrug-resistant organisms. Successful recovery was achieved through aggressive multidisciplinary care, including novel use of negative pressure wound therapy with acetic acid instillation. This case highlights the need for caution when re-irradiating the neorectum in the presence of a neorectal ulcer, and the importance of early surgical involvement in complex post-treatment complications.
2026-07-02 | Hemipelvectomy for Clostridium septicum necrotizing soft tissue infection with extensive pelvic organ destruction: a case report.
Clostridium septicum is a highly virulent, gas-forming, anaerobic Gram-positive bacillus known to cause rapidly progressive necrotizing soft tissue infection that is often associated with gastrointestinal malignancy or immunocompromised states. Mortality remains extremely high, with many patients dying within the first 24 h of onset. Although aggressive surgical debridement is the cornerstone of treatment, cases requiring hemipelvectomy are exceedingly rare, and postoperative management of exposed pelvic organs has not been described in the relevant literature. A 73-year-old woman with ascending colon cancer developed sudden severe left leg pain and paralysis, and computed tomography revealed extensive gas from the left thigh to the pelvis. Upon arrival at our tertiary center, she was in septic shock with gas rapidly progressing to the high retroperitoneum. Emergent hip disarticulation was performed, and Clostridium septicum was isolated. Despite early source control, ongoing toxin-mediated necrosis extending beyond the limits of limb amputation necessitated left hemipelvectomy on Day 4. Following radical debridement, postoperative management became extremely challenging because multiple pelvic organs were exposed, with necrosis of the bladder and perforation of ureter, rectum and vaginal wall. Serial debridement and staged repairs were required over a prolonged course. Granulation of the pelvic wound gradually progressed, allowing split-thickness skin grafting on Day 88, after which wound healing stabilized. She was ultimately stable enough to return to the referring hospital on Day 187. This is an extremely rare case of Clostridium septicum necrotizing soft tissue infection requiring hemipelvectomy, demonstrating that aggressive and timely radical debridement can be life-saving, even in cases with massive pelvic involvement. Furthermore, we present the first documented example of stepwise management of exposed pelvic organs after hemipelvectomy performed for necrotizing soft tissue infection, providing valuable insights for clinicians facing similar catastrophic presentations.
2026-06-29 | Pedicled Supraclavicular Flap Reconstruction Following Cervicofacial Necrotizing Fasciitis: A Case Report.
Cervicofacial necrotizing fasciitis is a life-threatening surgical emergency associated with significant morbidity and mortality, requiring early diagnosis and aggressive multimodal management. Reconstruction of the resulting soft tissue defects represents an additional challenge, particularly in resource-limited settings where microsurgical infrastructure may not be available. We report the case of a 42-year-old man who developed cervicofacial necrotizing fasciitis secondary to an odontogenic infection. Management consisted of broad-spectrum antibiotic therapy, early surgical debridement, and negative pressure wound therapy as a bridge to reconstruction. Once infection was controlled and a viable granulation tissue bed was established, definitive reconstruction was performed using a pedicled supraclavicular fasciocutaneous flap. The procedure was completed without complications, with satisfactory flap integration, cervicofacial contour restoration, and minimal donor site morbidity documented at outpatient follow-up. The pedicled supraclavicular flap proved to be a safe, reliable, and technically reproducible reconstructive option in this postinfectious context, offering an intrinsic vascular supply independent of the compromised recipient bed, a wide arc of rotation, and excellent color and texture match to cervicofacial skin. Its applicability in settings without microsurgical resources further supports its role as a first-line reconstructive strategy. This case contributes to the limited evidence on supraclavicular flap reconstruction following cervicofacial necrotizing fasciitis and underscores the value of a sequential, protocol-driven approach in achieving favorable outcomes.
Access all drug discovery articles and probability of success in trials forecasts:
Access all drug discovery articles and probability of success in trials forecasts:
Drug Discovery Landscape
2 orphan drug designations for Necrotizing soft tissue infection.
2 orphan drug designations for Necrotizing soft tissue infection.
Drug | Therapy type | Regulator | Orphan designation | Approval | Sponsor |
|---|---|---|---|---|---|
Sodium acetate salt of the synthetic peptide H-D-Ala-Ser-Pro-Met-Leu-Val-Ala-Tyr-Asp-D-Ala-OH | peptides | EMA | 2014-07-29 | — | FGK Representative Service GmbH |
reltecimod | peptides | FDA | 2011-10-12 | — | Atox Bio, Inc. |
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