Abstract
BackgroundNecrotising 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.MethodsThe 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.ResultsA 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.ConclusionThe 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.
Highlights
Necrotising fasciitis (NF) is a rapidly progressing soft tissue infection that frequently results in permanent disability and death despite parenteral antibiotic therapy and aggressive surgical management [1,2,3,4]
The Hospital Episodes Statistics database identified patients with NF admitted to English National Health Service (NHS) Trusts from 1/1/2002 to 31/12/2017
14,659 admissions to hospital for NF were identified between 1 January 2002 and 31 December 2017, using the ICD10 code M72.5 and M72.6
Summary
Necrotising fasciitis (NF) is a rapidly progressing soft tissue infection that frequently results in permanent disability and death despite parenteral antibiotic therapy and aggressive surgical management [1,2,3,4]. The patient may present with cellulitis, which rapidly progresses with pain disproportionate to the area of infection [7]. Necrotising fasciitis may be caused by a variety of aerobic and facultative anaerobic bacterial species, but is frequently polymicrobial. As many as 4 or 5 species may be cultured and the contribution of each to the pathogenesis of the disease is often not clear [1, 10]. Necrotising fasciitis (NF) is a rapidly progressive, destructive soft tissue infection with high mortality. The secondary aims included the identification of risk factors for mortality and causative pathogens
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