<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 63-year-old woman is brought to the emergency department by one of her neighbors because of fever and confusion. She has a 10-year history of diabetes mellitus and hemorrhoids. Her medications include insulin and metformin. Her blood pressure is 9070 mm Hg, the pulse is 115min, the respirations are 21min, and the temperature is 39.5C 103.1F. The cardiopulmonary examination shows no other abnormalities. The serum creatinine level is 2.5 mgdL. An MRI shows swelling of subcutaneous soft tissue and gas. She is resuscitated with IV fluids. Broad-spectrum empiric IV antibiotics are administered. Which of the following is the most appropriate next step in management?? A: Culture-based antibiotic therapy, B: High-dose IV steroids, C: Image-guided needle aspiration, D: Surgical debridement, E: No further management is indicated at this time,  <response>: This is a question about managing a 63-year-old woman with fever, confusion, and other symptoms concerning for necrotizing fasciitis. Based on the history, exam, and imaging findings of soft tissue swelling and gas, necrotizing fasciitis is likely. The key next step is urgent surgical debridement to remove infected and necrotic tissue. Broad-spectrum antibiotics are important but not sufficient alone. Steroids would be inappropriate. Needle aspiration is less invasive but also less effective than surgical debridement. No further management is not adequate.D: Surgical debridement 