Purpose: Necrotizing soft tissue infections (NSTI) are high morbidity and mortality infections that cause a significant burden to patients, are polymicrobial and increasing in incidence (1). This study was aimed at identifying risk factors and intervenable treatment factors for patients to improve their early identification and outcomes. Methodology: A retrospective cohort study was conducted of patients treated in a regional institution, assigned the ICD code associated with NSTI between 2014 and 2023 inclusive. Chart review was complete to ensure they were clinically consistent with NSTI and carried out with standard data points relating to demographics, important clinical milestones, disease features, investigations, management, and outcomes. Results: One hundred and forty-nine patients were identified with 60.1% of patients presenting to the primary institution and 39.8% from peripheral institutions with an overall 13.8% mortality rate. 60.4% of patients had severe infections requiring ICU admission and an average number of operations of 4.4. Male (61.1%) and ATSI (50.3%) of patients were overrepresented. The most significant comorbidities were diabetes (61.7%), ethanol use (38.2%), BMI >30 (36.2%) and smoking (36.2%). The most common site of infection was the lower limb (49.7%) and perineum (14.1%). 49% of patients had polymicrobial isolates from culture. Conclusions: Whilst a clinically highly variable disease, it is important to be aware of the major risk factors for NSTI to help generate a high index of suspicion assist in facilitating early and aggressive treatment of patients, to improve outcomes. (1) Vishnoi, et al, J Trop Dis 2018, 6:5