Current Concepts ReviewNecrotizing Fasciitis: Pillaging the Acute Phase ResponseHysong, Alexander A. MD1,*; Posey, Samuel L. MD1,*; Blum, Deke M. MD1,*; Benvenuti, Michael A. MD2; Benvenuti, Teresa A. BA2; Johnson, Samuel R. BS2; An, Thomas J. MD2; Devin, Jessica K. MD2; Obremskey, William T. MD, MPH2; Martus, Jeffrey E. MD2; Moore-Lotridge, Stephanie N. PhD2; Schoenecker, Jonathan G. MD, PhD2,aAuthor Information 1Vanderbilt University School of Medicine, Nashville, Tennessee 2Department of Orthopaedics and Rehabilitation (M.A.B., T.A.B., S.R.J., T.J.A., W.T.O., J.E.M., S.N.M.-L., and J.G.S.), Division of Diabetes, Endocrinology, and Metabolism (J.K.D.), and Departments of Pediatrics (J.E.M and J.G.S.), Pathology, Microbiology, and Immunology (J.G.S.), and Pharmacology (J.G.S.), Vanderbilt University Medical Center, Nashville, Tennessee aEmail address for J.G. Schoenecker: Jon.firstname.lastname@example.org *Alexander A. Hysong, MD, Samuel L. Posey, MD, and Deke M. Blum, MD, contributed equally to this work. Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJS/F691). The Journal of Bone and Joint Surgery: March 18, 2020 - Volume 102 - Issue 6 - p 526-537 doi: 10.2106/JBJS.19.00591 Buy Metrics Abstract ➤ Necrotizing fasciitis hijacks the acute phase response, increasing the risk of developing pathophysiologic states commonly associated with death: sepsis-induced coagulopathy (SIC), systemic inflammatory response syndrome (SIRS), and adrenal insufficiency, referred to as critical illness-related corticosteroid insufficiency (CIRCI). ➤ Dynamic monitoring of SIC, SIRS, and CIRCI may be informative when assessing infection severity and when directing treatment to manage these conditions as soon as they begin to develop. ➤ To reduce the risk of oropharyngeal colonization, N95 respirators should be worn by health-care professionals who are operating on patients with necrotizing fasciitis. Written work prepared by employees of the Federal Government as part of their official duties is, under the United States Copyright Act, a ‘work of the United States Government’ for which copyright protection under that Act is not available. As such, copyright protection does not extend to the contributions of employees of the Federal Government prepared as part of their employment.