Materiały źródłowe

• #1 Necrotizing Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430756/

  Necrotizing fasciitis affects about 0.4 per 100,000 people annually in the United States. It is as common in some areas as 1 in every 100,000 people.[6][7] […] Necrotizing fasciitis is a serious life-threatening infection with mortality rates ranging from 20 to 80%. Poor prognosis has been linked to certain streptococcal strains, advanced age, uncontrolled diabetes, state of immunosuppression, and delayed surgery. […] Necrotizing is a life-threatening disorder with a very high mortality rate. Any delay in diagnosis or treatment usually results in a poor outcome. […] Necrotizing fasciitis is a serious disorder that carries a mortality rate of anywhere from 30 to 90%. The mortality ultimately depends on the patient’s age, type of organism, the speed of diagnosis and treatment, and patient comorbidity.

• #2 Necrotizing fasciitis – Wikipedia

  https://en.wikipedia.org/wiki/Necrotizing_fasciitis

  Necrotizing fasciitis occurs in about 4 people per million per year in the U.S., and about 1 per 100,000 in Western Europe. About 1,000 cases of necrotizing fasciitis occur per year in the United States, but the rates have been increasing. This could be due to increasing awareness of this condition and increased reporting, or increasing antibiotic resistance. Both sexes are affected equally. It is more common among older people and is rare in children. […] Necrotizing fasciitis can occur at any part of the body, but it is more commonly seen at the extremities, perineum, and genitals. A small fraction of cases arise in the head/neck, chest and abdomen.

• #2 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  Necrotizing fasciitis is a rapidly progressive inflammatory infection of the fascia, with secondary necrosis of the subcutaneous tissues. The frequency of necrotizing fasciitis has been on the rise because of an increase in immunocompromised patients with diabetes mellitus, cancer, alcoholism, vascular insufficiencies, organ transplants, human immunodeficiency virus (HIV) infection, or neutropenia. […] According to the Centers for Disease Control and Prevention (CDC), an estimated 700-1150 cases of necrotizing fasciitis caused by group A Streptococcus occur annually in the United States. […] The mean age of a patient with necrotizing fasciitis is 38-44 years. This disease rarely occurs in children. Pediatric cases have been reported from resource-poor nations where poor hygiene is prevalent.

• #3 Incidence and mortality of necrotizing fasciitis in The Netherlands: the impact of group A Streptococcus | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06928-5

  Little is known about the exact incidence of necrotizing soft tissue infections. This resulted in the aim of this study to map the incidence, mortality rate and hospital course of necrotizing fasciitis infections in the Netherlands to gain insight in the incidence of necrotizing fasciitis in the Netherlands and the associated mortality and health care burden. […] The incidence of necrotizing fasciitis in the Netherlands is estimated to be approximately 1.1 to 1.4 cases per 100,000 person years, which corresponds to 193238 patients per year. Of all necrotizing fasciitis infections, 34 to 42% are caused by the group A Streptococcus. Annually, 56 patients die as a result of a necrotizing fasciitis infection (mortality of 2329%) and 26 patients undergo an amputation for source control (1114%).

• #4 Epidemiological Situation of Necrotizing Fasciitis and Factors in Thai | RMHP

  https://www.dovepress.com/epidemiological-situation-of-necrotizing-fasciitis-and-factors-in-thai-peer-reviewed-fulltext-article-RMHP

  Epidemiological Situation of Necrotizing Fasciitis and Factors in Thailand and Factors Associated with Its Morbidity and Mortality, 20142018 […] Necrotizing fasciitis (NF) is a rare skin and soft-tissue bacterial infection with high morbidity and mortality. Knowledge about the prevalence and incidence of NF in Thailand is quite sparse. The objective of this study was to determine the prevalence of NF in Thailand and factors that may be potentially associated with NF morbidity and mortality. […] During 2014 2018, we found 90,683 NF cases. About 4.86% of the cases died. The median age for all cases was 59.39 years old. The annual incidence of NF demonstrated an upward trend (from 26.08 per 100,000 population in 2014 to 32.64 per 100,000 population in 2018). The monthly incidence was highest between May and August. A high incidence cluster (as indicated by local Morans I) was found in the north-eastern region of Thailand.

• #5 Epidemiological Situation of Necrotizing Fasciitis and Factors in Thai | RMHP

  https://www.dovepress.com/epidemiological-situation-of-necrotizing-fasciitis-and-factors-in-thai-peer-reviewed-fulltext-article-RMHP

  The incidence of NF worldwide ranges from 0.3015 cases per 100,000 population. The mortality rate for Type 1 NF is 21% and for Type 2 NF is 1434%. The mortality rate for Type 1 NF is 21% and for Type 2 NF is 1434%. […] In 2017 and 2018, a variety of media agencies in Thailand reported that increasing numbers of people are affected by NF (in lay term, flesh-eating disease) in one of the north-eastern regions of Thailand. This study, also initiated by the DOE, is a deeper analysis aiming to explore the NF situation in terms of incidence and case fatality rate (CFR) and distribution by time, place and person. […] The incidence proportion of NF increased from about 26.08 per 100,000 in 2014 to 32.64 per 100,000 in 2018. Likewise, the case fatality ratio (deaths per patient) grew from about 4.30% in 2014 to 6.34% in 2018.

• #6 Explainer: what causes necrotising fasciitis, the flesh-eating bug?

  https://theconversation.com/explainer-what-causes-necrotising-fasciitis-the-flesh-eating-bug-49369

  Around 400 cases of necrotising fasciitis are diagnosed in Australian hospitals each year, which is similar to the incidence reported in other countries. […] Patient factors associated with infection include impaired immunity, obesity and chronic diseases such as diabetes. […] Some strains of bacteria produce toxins that can enable them to spread readily through tissue. Group A streptococci, for instance, produce a toxin called cysteine protease SpeB, which may allow the bacteria to dissolve tissue and evade the immune system.

• #7 Epidemiological Situation of Necrotizing Fasciitis and Factors in Thai | RMHP

  https://www.dovepress.com/epidemiological-situation-of-necrotizing-fasciitis-and-factors-in-thai-peer-reviewed-fulltext-article-RMHP

  The annual incidence proportion of NF cases per 100,000 population in each province was demonstrated in Figure 2. The north-eastern region appeared to have larger incidence compared with other regions. […] Overall, we found that the yearly incidence of NF in Thailand presented in this study was higher than reports in other countries such as Norway, Canada, and the US. This suggests that NF is likely one of the most critical public health threats in Thailand. […] The hot spot was identified in the Northeast of Thailand by local Morans I mapping. Spatial patterns of NF between 2014 and 2018 seemed to be consistent over time. […] The temporal analysis confirmed a temporal pattern of NF, either by additive model or multiplicative model. The multiplicative model seemed to better fit the data.

• #8 Necrotizing fasciitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/necrotizing-fasciitis-1?lang=us

  Necrotizing fasciitis is relatively rare, although its prevalence is rising. Over the past few years there has been an increase in vibriosis due to warming coastal and estuarine waters off East Coast USA, Gulf of Mexico and Australia. Vibriosis is a notifiable disease in the USA. […] The most common risk factor is diabetes mellitus, especially in combination with peripheral arterial disease. Other predisposing factors include immunocompromise due to HIV infection, cancer, liver disease, alcohol use, or organ transplant. […] Deep soft tissue infections can also occur in otherwise healthy individuals following surgery, penetrating trauma, minor wounds such as tattoos, piercings, insect bites or abrasions, or even blunt trauma with no clear portal of entry. Infections can enter wounds while bathing in warm coastal water or handling raw seafood. Bivalve filter-feeders such as oysters concentrate Vibrio species, especially if post-harvest temperature is too high. Coastal flooding exposes a larger population to infection.

• #9 Necrotizing Fasciitis of the Upper Extremity – A Review | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/35320-necrotizing-fasciitis-of-the-upper-extremity-a-review

  Among different studies, the annual incidence of NF varies between 500 and 1.500 cases reported in the United States each year, and its prevalence globally is estimated to be around 0,40 0,53 cases per 100.000 population annually. Its incidence is believed to be increasing over the last decade, mostly thanks to the amelioration of the reporting system, the augmentation of the diagnostic accuracy, and consequently the decrease of the formerly several misdiagnosed cases. Additionally, this can be attributed to the increased age and number of comorbidities in the population, as well as to the antibiotic abuse and its negative impact on the virulence of the pathogens. […] Although NF can affect all body parts, the extremities are the most common site of infection, described to be affected in 45 74% of all cases, with the lower extremities being most prevalent. NF of the upper extremities is less frequently reported, presenting frequencies varying between 6% and 27%.

• #10 Necrotizing fasciitis – EMCrit Project

  https://emcrit.org/ibcc/necfas/

  Epidemiology: Typically affects patients with comorbidities: Diabetes, Alcoholism, Obesity, Renal failure. […] Epidemiology of streptococcal necrotizing fasciitis: May affect anyone (often young and healthy people). There is a seasonal peak when throat infections increase (e.g., influenza season), as this is a potential portal of bacteria entry into the bloodstream. […] Increased risk associated with pregnancy (e.g., postpartum surgical site). […] Epidemiology: C. perfringens is associated with penetrating trauma, surgery, or IVDU. C. septicum may spread through the bowel and into the blood, presenting as spontaneous infection. Usually this is due to underlying colon cancer and/or immunosuppression (e.g. neutropenia, chemotherapy).

• #11 Pediatric Necrotizing Fasciitis

  https://www.jposna.org/index.php/jposna/article/view/728/909

  Compared to adult patients, pediatric NF is relatively rare with an estimated incidence of between 0.02 and 0.08 per 100,000 children per year. Incidence has been noted to be higher in children less than 5 years of age. Recent studies have shown that the incidence of pediatric NF has increased in recent years, perhaps due to better disease reporting and increased microbial virulence and resistance as a result of increased antibiotic use. […] Although NF infections in pediatric patients are rare, they are life-threatening, and early diagnosis is critical. Unlike in adults, NF in children typically occurs in otherwise healthy patients. Its initial presentation frequently mimics that of less serious skin infections, such as cellulitis. It is imperative that pediatric orthopaedic surgeons have a high level of clinical awareness and be up to date on emerging diagnostic tools like the P-LRINEC, which may aid in early diagnosis. It is essential that all children with suspected NF undergo early surgical debridement to prevent delay in treatment.

• #12 Aggressive Necrotizing Fasciitis in a 12-Year-Old Girl of Unknown Etiology: Diagnosis, Therapy, and Prognosis

  https://www.clinmedjournals.org/articles/ijfa/international-journal-of-foot-and-ankle-ijfa-6-072.php

  Necrotizing fasciitis (NF) is a severe form of soft tissue infection that spreads rapidly from the subcutaneous tissue and results in necrosis of the fascia and surrounding soft tissue. NF is rare in children and neonates and has been reported to occur at a rate of 0.08 per 100,000 children. It progresses rapidly and can lead to septic shock, organ failure, and death if not diagnosed early and treated radically. […] Mortality due to sepsis, disseminated intravascular coagulation (DIC), or organ failure has been reported most frequently, especially when there is more than 48 hours between the onset of symptoms and surgical treatment. […] Necrotizing fasciitis in children is often misdiagnosed as a simple soft tissue infection such as cellulitis, leading to a delay in treatment. […] NF is more common in patients with chronic diseases, following varicella infection, and in patients who have recently undergone surgery or trauma.

• #13 Necrotizing fasciitis epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Necrotizing_fasciitis_epidemiology_and_demographics

  The overall mortality rate of necrotizing fasciitis related deaths in the United States from 2003-2013 was 4.8/1,000,000 per year. […] The mortality rate in necrotizing fasciitis is approximately between 24-34%. […] The mortality rate of necrotizing fasciitis increases from 9% to 63% if associated with myositis and streptococcal toxic shock syndrome. […] Patients of all age groups may develop necrotizing fasciitis, however, it is slightly more common among patients 50 years age. […] Necrotizing fasciitis affects men and women equally. […] The incidence rate of necrotizing fasciitis is higher in Black, Hispanic, and American Indian individuals compared to Whites. […] The incidence rate is low in Asian populations. […] Necrotizing fasciitis is more common in developing countries because of low socioeconomic status and poor standards of hygiene.

• #14

  https://journals.lww.com/onlinejets/fulltext/2010/03020/hospital_epidemiology_of_emergent_cervical.5.aspx

  Out of 94 patients with NF, 5 (5.3%) had CNF. […] According to our study, CNF represents around 5% of NF patients. […] The only comorbidity associated was diabetes mellitus (DM) in 3 patients (60%). […] Sixty percent of the cases had type1 NF. […] The mean sequential organ failure assessment (SOFA) score on admission to the ICU was 8.8 3.6. […] Sixty percent of cases had multiorgan dysfunction (MODS) and one patient died, resulting in a mortality rate of 20%. […] In this study 80% of the patients presenting with CNF had used NSAIDs and 60% had a history of a dental surgical procedure as the predisposing factor. […] Male patients (60%) outnumbered the female patients, similar to the findings of a previous study where NF was more common in male patients. […] DM was the only comorbid disease seen in three (60%) of our patients.

• #15 Necrotizing Fasciitis – EyeWiki

  https://eyewiki.org/Necrotizing_Fasciitis

  Necrotizing fasciitis (NF), although relatively uncommon, was first recognized by Hippocrates in the fifth century BC. This disease is a severe infection characterized by a rapid and devastating progression involving the superficial fascia leading to skin necrosis. NF commonly affects the abdomen, extremities and perineum. It is associated with a high mortality rate of 25-30%. […] The incidence of NF in general is 3 per 100,000 with 10,000 new cases annually in the US. In a 2-year British prospective study, the incidence of periorbital NF was reported to be 0.24 per million per annum. […] The British Ophthalmology Surveillance Unit 2-year prospective study described a mortality rate of 10%. […] Mortality rate increases for NF that involves the lower part of the face and cervical area, areas closer to the mediastinum, chest and carotid sheath which may result in pulmonary complications. […] The key to the successful treatment of NF is early and aggressive diagnosis and treatment.

• #16 Necrotizing Fasciitis of the Upper Extremity – A Review | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/35320-necrotizing-fasciitis-of-the-upper-extremity-a-review

  The notable frequency and the great participation of intravenous drug use at the outset of NF of the upper extremity have already been underlined. […] NF often occurs in patients predisposed to infection because of some underlying chronic disease. Some conditions are remarkably more often associated with the development of NF, especially diabetes mellitus, which is a risk factor that appears in 21% – 71% of the cases. […] The role of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) has also been pointed out, though the exact way in which they contribute to the emergence of NF remains somehow controversial. […] The infection usually begins at the level of hypodermis and in the superficial fascia, as the outermost layers (dermis and epidermis) are not affected in the early stages. […] Cultures obtained from the site of injury in the operating room during surgical debridement are indispensable, tend to give positive results in 80% of the cases, and remain the key to the microbiological diagnosis of NF, which is achieved in approximately 75% of all cases.

• #17

  https://www.orthobullets.com/trauma/1007/necrotizing-fasciitis

  Necrotizing Fasciitis is a life-threatening bacterial soft tissue infection that spreads along soft tissue planes rapidly. […] Epidemiology […] Risk factors […] immune suppression […] diabetes […] AIDS […] cancer […] obesity […] bacterial introduction […] IV drug use […] hypodermic therapeutic injections […] insect bites […] skin abrasions […] abdominal and perineal surgery.

• #18 Pitfalls in Diagnosing Necrotizing Fasciitis | PSNet

  https://psnet.ahrq.gov/web-mm/pitfalls-diagnosing-necrotizing-fasciitis

  Necrotizing fasciitis (NF) is a rare disease. While SSTIs account for up to 14 million outpatient visits in the United States each year (4530 per 100,000), NF has an incidence of only 0.4 per 100,000 adults. The incidence of NF progressively increases among patients aged 50 years and older, reaching 12 per 100,000 in patients older than 80. Necrotizing fasciitis generally impacts patients with chronic illnesses; more than half of patients developing NF have pre-existing medical conditions and 35% have at least two. The majority of adults that acquire NF have at least one of the underlying diseases that will increase their susceptibility to infection. Despite improved recognition, NF continues to be associated with a high mortality; in the past decade, it is still reported to be between 15% to 45%.

• #19 The epidemiology of necrotizing fasciitis including factors associated with death and amputation | Epidemiology & Infection | Cambridge Core

  https://www.cambridge.org/core/journals/epidemiology-and-infection/article/epidemiology-of-necrotizing-fasciitis-including-factors-associated-with-death-and-amputation/26120FB05FC3C53C275065FB868D3E9A

  The high morbidity and mortality of necrotizing fasciitis (NF) supports the need for epidemiological studies to characterize the disease and identify patient factors associated with adverse outcomes. […] Select factors associated with mortality included evidence of underlying conditions (P=0002), advanced age (P=004), young age (P=003), and evidence of sepsis (P=0006). […] Select factors associated with amputation included diabetes mellitus (P=0006), evidence of underlying conditions (P=003), and cutaneous gangrene noted on admission (P=0006). […] The rapid course of the infection and this high morbidity/mortality despite treatment supports the need for additional studies to understand this disease and the patient factors associated with adverse outcomes. […] The mortality rate from NF in our study population (15%) is among the lowest of NF mortality rates published between 1924 and 1995 presented by McHenry et al.

• #20 Deaths from necrotizing fasciitis in the United States, 2003–2013 | Epidemiology & Infection | Cambridge Core

  https://www.cambridge.org/core/journals/epidemiology-and-infection/article/deaths-from-necrotizing-fasciitis-in-the-united-states-20032013/2C3843979ECB47FD1BBEDA652EE72EC1

  Necrotizing fasciitis (NF) is a life-threatening infection requiring urgent surgical and medical therapy. Our objective was to estimate the mortality burden of NF in the United States, and to identify time trends in the incidence rate of NF-related mortality. We obtained data from the National Center for Health Statistics, which receives information from death certificates from all states, including demographic information and cause of death. The U.S. Multiple Cause of Death Files were searched from 2003 to 2013 for a listing of NF (ICD-10 code M72.6) as either the underlying or contributing cause of death. We identified a total of 9871 NF-related deaths in the United States between 2003 and 2013, corresponding to a crude mortality rate of 48 deaths/1 000 000 person-years, without a significant time trend. Compared to white individuals, the incidence rate of NF-associated death was greater in black, Hispanic, and American Indian individuals, and lower in Asian individuals. Streptococcal infection was most commonly identified in cases where a pathogen was reported. Diabetes mellitus and obesity were more commonly observed in NF-related deaths compared to deaths due to other causes. Racial differences in the incidence of NF-related deaths merits further investigation.

• #21 Deaths from necrotizing fasciitis in the United States, 2003–2013 | Epidemiology & Infection | Cambridge Core

  https://www.cambridge.org/core/journals/epidemiology-and-infection/article/deaths-from-necrotizing-fasciitis-in-the-united-states-20032013/2C3843979ECB47FD1BBEDA652EE72EC1

  There are little data available regarding time trends in the epidemiology of NF in the United States, despite concerns for an increasing burden of skin and soft tissue infections due to pathogens such as methicillin-resistant S. aureus. Our objective was to estimate the mortality burden of NF in the United States over a 10-year period, and to identify temporal trends in the incidence of NF-related mortality during this period. […] In the United States from 2003 to 2013, the overall mortality rate for NF-related death was 48/1 000 000 p-yr. Contrary to our hypothesis, there was not a significant time trend in the number of cases of fatal NF during the study period. […] In an adjusted analysis using population census data, we observed a greater incidence rate in black, Hispanic, and American Indian individuals compared to white individuals, and a lower incidence rate in Asian individuals. The observed relationship between race/ethnicity and NF-related mortality is likely multifactorial in aetiology. […] In a matched case-control study, comorbid conditions associated with NF-related deaths in the United States were identified, based on sampling of death certificate data from the entire population. Diabetes mellitus, obesity, and renal failure were significantly associated with NF-related death.

• #22 Necrotizing Fasciitis of the Upper Extremity – A Review | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/35320-necrotizing-fasciitis-of-the-upper-extremity-a-review

  The average mortality rate of NF remains a controversial issue. It is generally accepted that without treatment, the mortality rate can reach 100% and that despite the advances in critical care management, antibiotics, and surgical treatment, mortality rates remain elevated and comparable to these of 46%, observed by Dr. Joseph Jones at his first description of NF back in 1871. Among different studies, NF presents a remarkably wide range of mortality rates, varying from 6% to 76%. […] As far as NF of the upper extremity is concerned, retrospective studies report mortality rates of 10% to 36%, while rates of amputation range from 11% to 38%. Nawijn et al. conducted a retrospective cohort study consisting of 122 patients with upper extremity NF and observed a 30-day mortality rate of 11% and an amputation rate of 14% (13 patients died and 17 underwent an amputation).

• #23 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  The reported mortality in patients with necrotizing fasciitis has ranged from 20% to as high as 80%. […] Poor prognosis in necrotizing fasciitis has been linked to infection with certain streptococcal strains. […] A retrospective study by Hsiao et al found that Aeromonas infection, Vibrio infection, cancer, hypotension, and band form white blood cell (WBC) count greater than 10% were independent positive predictors of mortality in patients with necrotizing fasciitis, while streptococcal and staphylococcal infections were not identified as predictors of mortality. […] A retrospective cohort study by Chang et al of patients with necrotizing fasciitis who underwent amputation reported that in those individuals in whom amputation was performed more than 3 days after admission, the mortality risk was higher when hemorrhagic bullae, peripheral vascular disease, or bacteremia was present or the laboratory risk indicator for necrotizing fasciitis (LRINEC) score was over 8. […] In another study, preexisting chronic liver dysfunction, chronic renal failure, thrombocytopenia, hypoalbuminemia, and postoperative dependence on mechanical ventilation represented poor prognostic factors in monomicrobial necrotizing fasciitis.

• #24 Association between time to surgery and hospital mortality in patients with community-acquired limb necrotizing fasciitis: an 11-year multicenter retrospective cohort analysis | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09501-y

  Necrotizing fasciitis (NF) is a rare but potentially life-threatening soft tissue infection. The objective of this study was to assess the association between timely surgery within 6 h and hospital mortality in patients with limb NF, and to describe the trends in patients with NF, time to surgery and standardized mortality ratio (SMR) over 11 years. […] The annual incidence of NF ranges from 1.7 cases per 100,000 population in New Zealand to 11.6 cases per 100,000 in Taiwan. […] A recent meta-analysis found that the mortality of NF remains high at 21% and survival has not improved over the last 20 years. […] The overall APACHE IV adjusted SMR is low for critically ill patients with limb NF in Hong Kong, but there was no significant decline in either median time to surgery or SMR over the 2008 to 2018 period.

• #25 Incidence and mortality of necrotizing fasciitis in The Netherlands: the impact of group A Streptococcus | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06928-5

  In the Netherlands, necrotizing fasciitis is a rare disease with group A Streptococcus being the most common causative micro-organism of necrotizing fasciitis. […] The Dutch mortality rate of necrotizing fasciitis (2329%) is slightly higher than the reported mortality rate of 1821% in recent international literature from selected centers and is slightly lower than the pooled mortality rate from the three previous Dutch cohort studies (28%). […] The Dutch mortality rate for GAS necrotizing fasciitis (17%) is comparable to that found in other European studies on GAS necrotizing fasciitis (1022%). […] The main focus should be to further reduce mortality by improving and facilitating prompt recognition of necrotizing fasciitis, followed by reducing the morbidity and improving long-term function and quality of life.

• #26

  https://link.springer.com/article/10.1007/s00068-021-01706-z

  Necrotizing fasciitis (NF) is a severe soft tissue infection with a high morbidity and mortality. […] The incidence of NF ranges widely. In Thailand, the annual incidence is 15.5 cases per 100,000. Whereas, it ranges from 0.3 to 5 cases per 100,000 in Western countries. […] The overall mortality was 31.7%. […] Other parameters found to be associated with mortality are age 60 years, cardiovascular disease in the medical history, 2 comorbidities, and lactate level greater than 1.7 mmol/L. […] The LRINEC score should be calculated in all patients presenting with NF to provide an additional source for clinical outcome. A high LRINEC score could implicate a higher risk of mortality. […] Predictors of a greater mortality found by previous studies are a white blood cell count greater than 30 10^9 L, creatinine level greater than 176.8 mol/L, heart disease, old age and female sex.

• #27 Necrotizing fasciitis: epidemiology and clinical predictors for amputa | IJGM

  https://www.dovepress.com/necrotizing-fasciitis-epidemiology-and-clinical-predictors-for-amputat-peer-reviewed-fulltext-article-IJGM

  Necrotizing fasciitis, a relatively uncommon infection involving the skin, subcutaneous tissue, and fascia, is a rapidly progressive soft tissue infection and a medical and surgical urgency. The purpose of this work is to describe the epidemiology of necrotizing fasciitis and to identify the clinical characteristics that may be used to predict amputation in routine clinical practice. Epidemiologic data for all patients with a surgically confirmed diagnosis of necrotizing fasciitis between 2009 and 2012 were collected. A total of 1,507 patients with a diagnosis of necrotizing fasciitis were classified as being with amputation (n=127, 8.4%) and without amputation (n=1,380, 91.6%). The incidence of NF in this cohort was 15.5 cases per 100,000 population in the Chiang Rai, Kamphaeng Phet, and Phayao provinces. The amputation rate for NF in this study was 8.4% (127 patients), which is less than in previous reports. Clinical predictors for limb loss in patients suspected of NF included having DM, soft tissue swelling, skin necrosis, gangrene, and serum creatinine values 1.6 mg/dL on admission. Thus, patients presenting any such clinical predictors should be aware of the risk of the disease progressing to amputation and attending health professionals should attempt to resolve these predictive factors as much as possible to decrease morbidity and mortality.

• #28 A review of necrotising fasciitis in the extremities | HKMJ

  https://www.hkmj.org/abstracts/v15n1/44.htm

  OBJECTIVE. To review currently available evidence on the epidemiology and methods of management for necrotising fasciitis, with particular reference to Hong Kong. […] The incidence of necrotising fasciitis in Hong Kong and around the world has been increasing. This rapidly progressive infection is a major cause of concern, due to its high morbidity and mortality. […] Early recognition and treatment remain the most important factors influencing survival. […] Many authorities have reported that carrying out the first fasciotomy and radical debridement within 24 hours of symptom onset was associated with significantly improved survival, which also emphasises the importance of early diagnosis. […] The timing of the first fasciotomy and radical debridement within a window of 24 hours from symptom onset is associated with significantly improved survival.

• #29 Pitfalls in Diagnosing Necrotizing Fasciitis | PSNet

  https://psnet.ahrq.gov/web-mm/pitfalls-diagnosing-necrotizing-fasciitis

  A high index of suspicion for NF is needed when SSTIs are encountered. In NF, early diagnosis and adequate debridement within 24 hours is the most important factor impacting survival. Patients who receive surgery in the first 24 hours have a mortality rate of 4.2% to 6.7%; those whose surgery is delayed more than 24 hours have mortality rates of 23% to 75%, representing an increase of relative risk for death of 9.4 times. […] Early diagnosis of NF is notoriously difficult and misdiagnosis is common. In one study, NF was misdiagnosed 71.4% of the time. Most patients were often treated empirically for non-specific sepsis before a diagnosis of NF was made. There are multiple factors that contribute to mis- or delayed diagnosis. First, NF is a rare disease and hence many practitioners may be encountering it for the first time. Second, NF can present at first in a way that is indistinguishable from other common soft tissue infections. Recognition of the „hard signs” (bullae, numbness, crepitus, and skin necrosis) that distinguish NF will help the clinician make the diagnosis. Unfortunately, such signs are present in only 43% of these patients. Broad-spectrum antibiotics are often given for suspected infection and can mask the severity of the underlying infection. Third, the cutaneous signs of NF usually lag behind the disease pathology; there can be extensive bacterial load and tissue destruction under the skin with very little in the way of cutaneous manifestations. Fourth, systemic signs of NF may not correlate with the cutaneous signs and vice versa; even patients with extensive infection may not be systemically ill.

• #30 Head and neck necrotising fasciitis: an Australian rural experience – You – Australian Journal of Otolaryngology

  https://www.theajo.com/article/view/4767/html

  HN NF is a life-threatening infection that is difficult to diagnose and manage, especially in rural Australian settings. High clinical suspicion and early diagnosis is required to overcome the logistical and geographical barriers. […] In rural and regional areas, NF diagnosis and treatment is further complicated by limited resources for adequate investigations, operative treatments, and timely transfer to a centre for definitive management. […] This study demonstrates that with multidisciplinary approach, swift interhospital coordination, and ongoing education, favourable outcomes can be achieved for HN NF in rural ENT service. […] Management requires prompt recognition and early aggressive debridement. This is particularly challenging in rural Australia where patients experience further unexpected delays due to logistical barriers and need for transfers to tertiary hospitals for definitive management.

• #31

  https://www.gov.uk/guidance/necrotising-fasciitis-nf

  There are no ongoing surveillance programmes that capture data on NF cases caused by all organisms. […] Data is available for NF caused by Streptococcus pyogenes (GAS) captured as part of research studies.

• #32 Show content

  https://digitalmedia.hhs.gov/storefront/showContent/858

  Recent media stories about 'flesh-eating’ bacteria may have you worried. But CDC’s cutting-edge tracking methods, like Active Bacterial Core surveillance (ABCs), show no rise in annual cases.

• #33 Necrotising Fasciitis – RCEMLearning

  https://www.rcemlearning.co.uk/reference/necrotising-fasciitis/

  Necrotising fasciitis is a rare but life threatening bacterial soft tissue infection. It is associated with significant mortality of approximately 20-40%, even with appropriate treatment, and morbidity from skin and soft tissue loss. Current literature suggests that there are approximately 500 new cases of necrotising fasciitis occurring annually in the UK. However, as there is no ongoing surveillance programme, this is felt to be an underestimation. […] Mortality is directly proportional to delay in diagnosis and treatment. […] Necrotising fasciitis is difficult to diagnose early due to the non-specific nature of its early features. It is often misdiagnosed for cellulitis and requires a high index of suspicion to identify. […] As an adjunct to clinical judgement, scoring systems such as the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) have been developed to help differentiate necrotising fasciitis from other soft tissue infections. Scores of six or more should raise the suspicion of NF and a score of eight or more is strongly predictive of the disease.

• #34 Information For Health Professionals on Necrotizing Fasciitis – MN Dept. of Health

  https://www.health.state.mn.us/diseases/necfac/hcp.html

  All cases of Group A Streptococcus that result in necrotizing fasciitis are reportable to the Minnesota Department of Health. […] All invasive streptococcal disease caused by group A streptococci must be reported to MDH within one working day.

• #35 Necrotizing Fasciitis (Flesh-Eating Disease): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23103-necrotizing-fasciitis

  The number of cases of necrotizing fasciitis is estimated to be 0.3 to 15 per 100,000 people, but this is likely less than the true number. […] Between 2010 and now, the number of reported cases of necrotizing fasciitis caused by group A strep bacteria ranged from 700 to 1,200 per year. […] These numbers are likely to be lower than the actual total number of cases of necrotizing fasciitis.

• #36 Pediatric Necrotizing Fasciitis

  https://www.jposna.org/index.php/jposna/article/view/728/909

  Despite the potentially grave consequences of NF for children, research in the field is lacking due to the extremely low incidence of pediatric NF and the difficulty of developing assessment and treatment recommendations from these small series. Systematic multi-institutional studies are needed to develop and validate prognostic tools such as the P-LRINEC.

• #37 Epidemiological Situation of Necrotizing Fasciitis and Factors in Thai | RMHP

  https://www.dovepress.com/epidemiological-situation-of-necrotizing-fasciitis-and-factors-in-thai-peer-reviewed-fulltext-article-RMHP

  In terms of public health implications, the Thai DDC should develop a sentinel surveillance system for NF, especially in the northeastern region of Thailand. […] The incidence of NF in Thailand is on the rise. The northeastern region is an area where NF cases are concentrated. In-depth analysis revealed that the elderly and patients with undermined immune systems, particularly diabetes, cirrhosis and malignancy, were at greater risk of amputation and death. Further studies that examine patients data at a household level are of substantial value for public health implications.

• #38 The epidemiology of necrotizing fasciitis including factors associated with death and amputation | Epidemiology & Infection | Cambridge Core

  https://www.cambridge.org/core/journals/epidemiology-and-infection/article/epidemiology-of-necrotizing-fasciitis-including-factors-associated-with-death-and-amputation/26120FB05FC3C53C275065FB868D3E9A

  The most significant patient characteristic associated with an increased risk of death was the presence of two or more comorbid conditions. […] The increased mortality observed in the extremes of age, young and old, noted here in multivariable analysis could indicate a U-shaped association between age and mortality in NF. […] This report demonstrates the substantial morbidity and mortality of NF and adds to the understanding of the epidemiology of NF by demonstrating factors associated with survival in a large number of confirmed NF case-patients in multiple health-care centres.

• #39 Head and neck necrotising fasciitis: an Australian rural experience – You – Australian Journal of Otolaryngology

  https://www.theajo.com/article/view/4767/html

  Despite these challenges, most HN NF patients managed at TBH ENT department underwent their treatment and reconstruction locally, with only two patients requiring transfers for further subspecialty input. […] This is the first article to date exploring these challenges and reviewing current management and outcomes of HN NF infections in a rural Australian setting. […] Once diagnosis, or clinical suspicion, of HN NF has been made, there are multiple barriers in rural and regional areas that further delay definitive operative intervention. […] This study is the first in literature to explore management of HN NF in rural and regional Australia, and demonstrates that with multidisciplinary approach, swift interhospital coordination, and ongoing education, favourable outcomes can be achieved for these patients.

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