Localised increase in necrotising fasciitis associated with a shift to monomicrobial aetiology, South Yorkshire, England, 2023.

OBJECTIVES

An increase in necrotising fasciitis (NF) was observed in South Yorkshire by plastic surgeons. A public health response was established.

METHODS

Data were collected on NF cases from 2023 and 2019 (control group) from two hospitals in South Yorkshire. Data on demographics, risk factors, co-morbidities and outcome were obtained. Microbiological data were extracted from hospital laboratory information systems. A survey was sent to plastic surgery departments in England to enquire if similar increases had been observed.

RESULTS

Data were collected on 33 cases of NF in 2023. Of the 32 cases with ≥1 microorganism isolated, 26 were monomicrobial NF and 6 polymicrobial NF. 9 NF cases were admitted to the hospitals in 2019. Cases in 2023 and 2019 had broadly similar demographics and co-morbidities. NF cases in 2023 were characterised by limb foci, group A streptococcus isolations, and wound infection (chronic, traumatic, or surgical) or ulcer. Case fatality rate for 2023 NF cases was 38% (12/32) compared to 25% (2/8) in 2019.

CONCLUSIONS

In 2023, we observed a substantial rise in NF in South Yorkshire, characterised by a shift from predominantly Type I NF (polymicrobial) in 2019 to Type II and Type III NF (monomicrobial). The causes of this increase require further investigation and are likely multifactorial.