Necrotizing soft tissue infections — commonly known as necrotizing fasciitis, or "flesh-eating bacteria" — are among the most dangerous emergencies in medicine. These infections spread rapidly through skin, fat, and fascia, and despite prompt surgery and antibiotics, mortality rates have historically ranged from 20% to 40%. Hyperbaric oxygen therapy (HBOT) is a Medicare-covered, FDA-approved adjunctive treatment recognized for its role in improving survival in these life-threatening cases.

Why Oxygen Matters in a Bacterial Emergency

Necrotizing infections thrive in low-oxygen tissue, and many of the most dangerous organisms involved are anaerobic bacteria that grow best in exactly these conditions. According to the Undersea and Hyperbaric Medical Society (UHMS), restoring high oxygen levels to infected tissue helps fight the infection on two fronts: it directly inhibits the growth of anaerobic bacteria, and it restores the function of neutrophils, the white blood cells responsible for killing bacteria, which require adequate oxygen to work effectively.

What the Research Shows

The evidence base for HBOT in necrotizing soft tissue infections has grown substantially in recent years. A large systematic review and meta-analysis, drawing on data from more than 49,000 patients across 23 studies, found that patients treated with HBOT had significantly lower mortality than those who received standard care alone.

This finding is consistent with decades of clinical experience. UHMS cites early research showing that combining hyperbaric oxygen with antibiotics and radical surgical debridement reduced necrotizing fasciitis mortality from a historic rate of 38% down to 12.5%. A more recent retrospective cohort study similarly found that patients who did not receive HBOT were significantly more likely to die within 90 days than those who did, with the benefit most pronounced in patients with large wounds and higher illness-severity scores.

It's worth noting that the evidence isn't unanimous — some retrospective studies have found more modest effects, and researchers agree that large, prospective randomized trials are still lacking. What the current body of research consistently supports, however, is that HBOT is a reasonable and often life-saving adjunct for eligible patients when added to timely surgery and antibiotics, not a replacement for either.

Medicare and Insurance Coverage

Progressive necrotizing infections are explicitly listed as a covered condition under Medicare's National Coverage Determination for hyperbaric oxygen therapy (NCD 20.29). This means that for eligible patients, Medicare reimbursement is available for HBOT administered alongside standard surgical and antibiotic treatment — an important consideration for patients and families navigating a medical emergency.

What This Means for Patients

Necrotizing soft tissue infections require immediate emergency surgical care — HBOT is never a substitute for urgent debridement and antibiotics, but rather an adjunct used alongside them, typically beginning as soon as the patient is medically stable enough to tolerate treatment.

Safety and Expert Care

As a Medicare-covered, FDA-approved indication, HBOT for necrotizing soft tissue infections reflects a strong and growing body of clinical evidence. At Bay Area Hyperbarics, this treatment is delivered under expert care with a focus on patient safety at every stage of a medical emergency.

Consult a healthcare provider before starting any new treatment. This article is for educational purposes and does not replace medical advice from your care team.

If you or a loved one is facing a necrotizing infection, seek emergency medical care immediately — then reach out to our team to learn how hyperbaric oxygen therapy can support recovery.