Role of Rapid Microbiological Diagnostics in Early Surgical DecisionMaking for Necrotizing Soft Tissue Infections

Background: Necrotizing soft tissue infections (NSTIs) are rapidly progressive, life-threatening conditions requiring emergent surgical debridement. Early pathogen identification may optimize antimicrobial therapy and guide surgical management, yet the clinical impact of rapid microbiological diagnostics on surgical decisionmaking remains incompletely characterized. Methods: A prospective cohort study was conducted over 36 months, enrolling 142 patients with confirmed NSTIs. Rapid diagnostics including Gram stain, direct molecular testing (multiplex PCR), and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) were compared to conventional culture. Time to pathogen identification, antimicrobial modification rates, surgical decision impact, and clinical outcomes were evaluated. Results: Rapid diagnostics provided actionable results in a median of 2.8 hours compared to 48.6 hours for conventional culture (p