Epidemiology

Absolute data for the incidence and prevalence of necrotizing fasciitis are lacking and may vary by geographic location. The incidence is higher in adults compared with children (estimated at 0.4 per 100,000 per year versus 0.08 to 0.13 per 100,000 per year).[21] Type I (due to mixed anaerobic-facultative anaerobic infections) is more common than type II necrotizing fasciitis overall, whereas group A streptococcal type II necrotizing fasciitis is the most common in children.[21][22]

US-based multisite surveillance data from 2023 show that necrotizing fasciitis complicated 5.9% of invasive group A streptococcal infections, with 266 cases per year.[23] 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, 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][5][16]

nontraumatic 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][5][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 generalized immunosuppressed state as a consequence of longstanding disease (alcoholism, diabetes mellitus, cardiac or pulmonary disease, peripheral vascular disease, renal failure) may predispose to soft-tissue infections.[1][3][5][16][30]

immunosuppression

Immunosuppression due to malignancy and/or chemotherapy or radiation therapy, drugs (especially chronic corticosteroid use), or infection (HIV) may predispose to soft-tissue infections.[3] Immunosuppressed status may lead to a delay in diagnosis and surgical management leading to greater risk of death.[16][25][31]

use of nonsteroidal anti-inflammatory drugs (NSAIDs)

It has been postulated that use of NSAIDs may mask symptoms of necrotizing fasciitis, delaying diagnosis, and that suppression 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][33] However, good evidence for the association of NSAIDs and necrotizing fasciitis in humans is not available.

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