Seasonal Variation of Group a Streptococcus (GAS) – Related Necrotising Fasciitis Cases in a UK Teaching Hospital



E. Gkrania-Klotsas1, *, R.C. Chew2, K. Vrotsou3
1 Box 25/Ward D10, Addenbrooke’s Hospital, Cambridge, CB2 2QQ, UK
2 University of Cambridge Medical School, Peterhouse, Cambridge, CB2 1RD, UK
3 Centre for Applied Medical Statistics, Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Institute of Public Health, Robinson Way, Cambridge CB2 2SR, UK


© 2008 Gkrania-Klotsas et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Box 25/Ward D10, Addenbrooke’s Hospital, Cambridge, CB2 2QQ, E-mail: UK.egkraniaklotsas@nhs.net


Abstract

Objectives:

Necrotizing fasciitis is a diverse syndrome primarily involving the fascia but also occasionally the overlying skin and underlying muscles. Non-necrotising lower limb cellulitis has been reported to have a marked seasonal variation in our area. We are describing the seasonal variation of our necrotising fasciitis cases.

Methods:

The medical records of all the patients that were admitted to our institution with a diagnosis of necrotizing fasciitis, from January 1994 to December 2003, were retrospectively reviewed.

Results:

The necrotising fasciitis infections peaked every year in the spring time, as previously described for cellulitis. The increased incidence was only apparent for group A streptococcus related necrotising fasciitis cases. The diagnosis carried 21% mortality during the same admission. Overall, 39% of the patients had a bad outcome, defined as either death during the same admission, limb amputation or severe disability. 73% of patients who experienced a bad outcome were found to have Group A streptococcus compared to only 41% of the patients in the good outcome group.

Conclusions:

A seasonal variation was noted for Group A streptococcus associated necrotising fasciitis, that remains a lethal condition. As patients with Group A streptococcus associated necrotising fasciitis tend to have a worse outcome in our series, increased awareness and targeted antibiotic therapy may enhance clinical outcomes. Knowledge of microbiology might also inform infection control decisions.

Keywords: Necrotising fasciitis, Group A Streptococcus, Epidemiology.