Necrotizing Fasciitis: On the Rise

Author(s):
Kelsey Musgrove; Melissa LoPinto; Gerald Hobbs; Brian Hendricks; Eric Lundstrom; Kimberly Bailey

Background:

Background: Cases of necrotizing fasciitis have been historically rare, with 0.3-15 cases per 10,000 depending on state. Review of electronic health records from West Virginia (WV) University’s Ruby Memorial Hospital revealed a dramatic increase over what was expected given national trends over the last decade. The purpose of our case review study was to examine national trends and compare with what we have observed in WV.

Methods:

Methods: Retrospective record review was done for WV for patients treated at WV University from 1995, and nationally using the Healthcare Cost and Utilization Project (HCUP) data from 2000-2011. Patients were identified using ICD9/10 code M72.6. Regression and spatial cluster analyses were estimated using state-level rates per 100,000 for 2000-2010.

Results:

Results: All data show an increase in rates of necrotizing fasciitis over the last 5-15 years. National rates increased from as low as 0.85 per 100,000 in 2001 to 1.13 per 100,000 in 2011. Thematic mapping revealed general trends in geographic distribution of cases, with higher reporting on both U.S. coasts, while reports decreased in Middle America. Despite observed trends, no significant spatial clustering of cases was detected using Global Moran’s I (I = 0.031, P = 0.25). WV specific regression analyses indicated a trend towards more cases of polymicrobial infection without evidence of changing patient demographics.

Conclusions:

Conclusion: National and WV specific incidence increased over time. Increased rates in disease coincided with increasing trends in obesity and diabetes at the national and state level. No apparent effect was observed between necrotizing fasciitis and rate of Strep Group A infection. Preliminary work suggests the etiology for the infection is most likely multi-factorial. More research is required to understand and compose interventions to mitigate this concerning trend.