Background. Necrotizing soft tissue infections represent a distinct category of surgical infections associated with rapid progression, systemic inflammatory response, and high mortality. The development of surgical sepsis in these patients remains unpredictable and may occur despite timely and radical surgical treatment, particularly in the presence of significant comorbidities.

Methods. A retrospective analysis was performed on 143 patients treated for necrotizing soft tissue infections. Surgical sepsis was defined according to Sepsis-3 criteria. Patients were evaluated with respect to comorbid conditions, clinical course, need for intensive care, progression to septic shock and multiple organ failure, and in-hospital mortality.

Results. All patients with necrotizing soft tissue infections demonstrated a potential risk of septic complications. In patients with pronounced comorbidity, including diabetes mellitus and HIV infection, sepsis frequently followed a fulminant course with rapid progression to septic shock, multiple organ failure, and high mortality. In patients without severe comorbidities, sepsis often developed in a subacute manner with transient clinical stabilization, which could mask ongoing systemic infection and delay intensive anti-septic therapy. Progression to septic shock and the need for treatment in the intensive care unit were strongly associated with adverse outcomes.

Conclusion. Necrotizing soft tissue infection should be regarded as a condition with an inherent and unpredictable risk of surgical sepsis. Apparent local improvement does not exclude systemic progression. Continuous assessment for septic manifestations and early initiation of comprehensive anti-septic therapy is essential, even in the presence of radical surgical source control.

Necrotizing soft tissue infection, surgical sepsis, comorbidity

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