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. 2020 Aug;44(8):2580-2591.
doi: 10.1007/s00268-020-05559-2.

A 16-year Longitudinal Cohort Study of Incidence and Bacteriology of Necrotising Fasciitis in England

David M S Bodansky  1 , Irena Begaj  2 , Felicity Evison  2 , Mark Webber  3 , Ciaran B Woodman  4 , Olga N Tucker  5
Affiliations

A 16-year Longitudinal Cohort Study of Incidence and Bacteriology of Necrotising Fasciitis in England

David M S Bodansky et al. World J Surg. 2020 Aug.

Abstract

Background: Necrotising fasciitis (NF) is a rapidly progressive, destructive soft tissue infection with high mortality. The primary aim of this study was to evaluate the incidence and mortality of NF amongst patients admitted to English National Health Service (NHS) hospitals. The secondary aims included the identification of risk factors for mortality and causative pathogens.

Methods: The Hospital Episodes Statistics database identified patients with NF admitted to English NHS Trusts from 1/1/2002 to 31/12/2017. Information on patient demographics, co-morbid conditions, microbiology specimens, surgical intervention and in-hospital mortality was collected. Uni- and multivariable analyses were performed to investigate factors related to in-hospital mortality.

Results: A total of 11,042 patients were diagnosed with NF. Age-standardised incidence rose from 9 per million in 2002 to 21 per million in 2017 (annual percentage change = 6.9%). Incidence increased with age and was higher in men. Age-standardised mortality rate remained at 16% over the study period, while in-hospital mortality declined. On multivariable analysis, the following factors were associated with increased risk of in-hospital mortality: emergency admission, female sex, history of congestive heart failure, peripheral vascular disease, chronic kidney disease and cancer. Admission year and diabetes, which was significantly prevalent at 27%, were not associated with increased risk of mortality. Gram-positive pathogens, particularly Staphylococci, decreased over the study period with a corresponding increase in Gram-negative pathogens, predominantly E. coli.

Conclusion: The incidence of NF increased markedly from 2002 to 2017 although in-hospital mortality did not change. There was a gradual shift in the causative organisms from Gram-positive to Gram-negative.

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Conflict of interest statement

The author declares that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Age standardised rate of admissions to hospital for patients with necrotising fasciitis and of mortality. The rate of admissions rose from 9 per million population in 2002 to 16 per million in 2017. The rate of admissions resulting in death remained constant across the study period
Fig. 2
Fig. 2
Age standardised rate of admissions and of mortality for emergency admissions of patients with necrotising fasciitis requiring surgery. For those patients with necrotising fasciitis receiving surgery, the rate of admission rose from 4 per million population in 2002 to 12 per million population in 2017. However the standardised rate of admissions that resulted in death fell during the study period
Fig. 3
Fig. 3
Change in pathogens from patients receiving surgery over time. Although the proportion of Gram-positive organisms overall fell during the study period, streptococci specii remained high whilst staphylococci specii dropped. Gram-negative isolated specii became more common, in particular E. coli
See this image and copyright information in PMC

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