Epidemiology

Absolute data for the incidence and prevalence of necrotising fasciitis are lacking. Type I (due to mixed anaerobic-facultative anaerobic infections) is more common than type II necrotising fasciitis.[21]​[22]​​​

An estimated 500 people present with necrotising fasciitis each year in the UK, with an incidence of 0.4 to 0.53 cases per 100,000 population.[23]

US-based multi-site surveillance data from 2021 showed that necrotising fasciitis complicated about 4.5% of invasive group A streptococcal infections, with approximately 100 cases per year.[24]

The overall prevalence, incidence, and epidemiology remain stable.

Risk factors

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inpatient contact with index case

Patient to patient spread of group A streptococcal infection (a common cause of necrotising fasciitis), with median interval of 4 days to spread from index case to second case.[1][30]

Varicella zoster infection

Serves as a cutaneous portal of entry for infective organisms.[1][30]

cutaneous injury, surgery, trauma

Serve as a cutaneous portal of entry for infective organisms.​[1][2][16]

non-traumatic skin lesions

Chronic or acute skin conditions, for example, eczema, psoriasis, cutaneous ulcers, and burns, may serve as a cutaneous portal of entry for infective organisms​[1][2][16]​​​[30]

intravenous drug use

Intravenous drug use provides a cutaneous portal of entry for infective organisms.[16]​

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chronic illness

A generalised immunosuppressed state as a consequence of long-standing disease (alcohol dependence, diabetes mellitus, cardiac or pulmonary disease, peripheral vascular disease, renal failure) may predispose to soft-tissue infections​​[1][2][4][16]​​​​[30]​​​

immunosuppression

Immunosuppression due to malignancy and/or chemotherapy or radiotherapy, medications (especially chronic corticosteroid use), or infection (HIV) may predispose to soft-tissue infections.[4]​ Immunosuppressed status may lead to a delay in diagnosis and surgical management leading to greater risk of death.​​[31]

non-steroidal anti-inflammatory drugs (NSAIDs)

It has been suggested that use of NSAIDs may mask symptoms of necrotising fasciitis, delaying the diagnosis, and that supression of neutrophils and alterations of cytokine production caused by NSAIDs may impair response to infection and allow progression to severe disease. In an animal model of group A streptococcus soft-tissue infection, ibuprofen worsened disease and increased mortality.​[32]​ However, good evidence for the association of NSAIDs and necrotising fasciitis in humans is not available.

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