Changes in the epidemiology and prognosis of Streptococcus pyogenes necrotizing fasciitis after COVID-19: Insights from a university hospital
Keywords:
Streptococcus pyogenes, necrotizing fasciitis, COVID 19, group A streptoccocus, fasciotomyAbstract
Background and aim: Following the COVID-19 pandemic, numerous countries have reported a significant increase in invasive Streptococcus pyogenes infections. Our aim was to analyze the epidemiology, clinical characteristics, morbidity, and prognosis of patients with S. pyogenes-associated necrotizing fasciitis in the post-COVID-19 era.
Methods: This retrospective study was conducted at a university hospital and included all consecutive adult patients (≥18 years) diagnosed with S. pyogenes-associated necrotizing fasciitis between 2012 and 2023. Two study periods were compared: pre-COVID-19 (2012–2019) and post-COVID-19 (2020–2023). The primary objective was to determine incidence (admissions per 100,000 inhabitants). Secondary outcomes included in-hospital mortality, length of hospital stay and intensive care unit admissions between the periods.
Results: A total of 34 cases were included: 17 in the pre-COVID-19 period and 17 in the post-COVID-19 period, with an incidence of 0.42/100,000 vs. 1.13/100,000 inhabitants-year, respectively (P<0.01). Compared to the pre-COVID-19 period, patients in the post-COVID-19 period had lower Charlson comorbidity index score (median 2 vs. 5, P=0.04), and required fewer fasciotomies (median 1 vs. 3, P=0.01). In-hospital mortality was 17.6% in both periods, while the length of hospital stay was shorter in the post-COVID-19 period (median 15 vs. 29 days, P=0.04).
Conclusions: Our findings reveal an increased incidence of S. pyogenes-associated necrotizing fasciitis following the COVID-19 pandemic, predominantly affecting younger patients with lower comorbidity and showing a trend toward better clinical outcomes. Further studies are needed to better understand the underlying factors driving these changes.
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Copyright (c) 2026 Álvaro Guzmán-Sánchez, Sofía de la Villa, Jose María Hernández-Mateo, María Asunción García-Quirós, Antonio Benjumea, Jose Antonio Matas, Mar Sánchez-Somolinos, Javier Vaquero, Pablo Sanz-Ruiz
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