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Necrotizing soft tissue infection — MCCQE Part 1 MCQ

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HardWoundsNecrotizing soft tissue infectionMCCQE Part 1

A 59-year-old woman with diabetes presents with severe thigh pain after a minor scratch. She is febrile, hypotensive, and has dusky skin with crepitus. White blood cell count is 24 × 10^9/L and lactate is 4.8 mmol/L. What is the most appropriate next step in management?

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Correct answer: B — Immediate broad-spectrum antibiotics and urgent surgical debridement

Pain out of proportion, toxicity, crepitus, skin discoloration and raised lactate suggest necrotizing soft tissue infection, requiring antibiotics and urgent debridement. Imaging can support diagnosis but must not delay surgery in a toxic patient. Oral cellulitis treatment is inadequate.

Reference: Association of Medical Microbiology and Infectious Disease Canada SSTI guidance