Necrotizing soft tissue infections (NSTI) are an uncommon, but aggressive, problem with a potential for high morbidity and mortality rates. Establishing the diagnosis can be the major challenge.Review of pertinent English-language literature.Early, aggressive surgical debridement combined with empiric broad-spectrum antibiotic therapy form the cornerstones of management. Novel therapeutic strategies such as hyperbaric oxygen, intravenous immunoglobulin, extracorporeal plasma treatment, and drotrecogin alfa (activated), also have been described, although their roles remain ill-defined.Early diagnosis, despite its difficulties, is essential to guide the implementation of appropriate life-saving therapies. Understanding the microbiology of NSTI is important, not only to guide antibiotic therapy, but also to provide insight into the pathogenesis of the disease that will permit the future development of rationally targeted interventions.