Related Experiment Video
Updated: Oct 25, 2025
Application of Lucilia sericata Larvae in Debridement of Pressure Wounds in Outpatient Settings
Published on: December 4, 2021
Global patterns of necrotizing soft tissue infections: A systematic review and meta-analysis
Chathurika S Dhanasekara1, Brianna Marschke1, Erin Morris1
1Department of Surgery, Texas Tech University Health Science Center, Lubbock, TX.
Background:
Frequency, microbiology, and outcomes of necrotizing soft tissue infections vary based on locoregional and environmental factors; however, there has been no global survey of these patterns. We performed a systematic review/meta-analysis on published reports of necrotizing soft tissue infections from across the globe.
Methods:
Peer-reviewed empirical studies examining rates of polymicrobial and monomicrobial necrotizing soft tissue infections with microbial isolation and overall mortality rate were extracted along with geographic location using PubMed, Scopus, ProQuest, and Web of Science. Random-effects meta-analyses and sensitivity analyses were performed, adjusting for publication bias. Meta-regression analyses examined moderator effects of risk factors.
Results:
One hundred and five studies (8,718 total patients) were included. Pooled prevalence of polymicrobial and monomicrobial infections were 53% and 37.9%, respectively. Truncal necrotizing soft tissue infections were commonly polymicrobial (P < .001), whereas monomicrobial infections prevailed in extremities (P = .008). Global prevalence of monomicrobial necrotizing soft tissue infections was observed to increase by 1.1% annually (P = .003). Staphylococcus aureus was the most common organism globally and in North America, Asia, the Middle East, and Africa, followed by Streptococcus pyogenes and Escherichia coli. Methicillin-resistant S. aureus accounted for 16% of necrotizing soft tissue infections globally. Overall mortality was 23.1%, observed to decline globally over the last decade (P = .020). No regional differences were noted for mortality.
Conclusion:
Although polymicrobial infections remain predominant worldwide, the incidence of monomicrobial infections is increasing. The observed decline in necrotizing soft tissue infection-related mortality is encouraging and may reflect advances in management, despite major variations in available healthcare resources globally.
Insights
Necrotizing soft tissue infections (NSTIs) are often polymicrobial, but monomicrobial cases are rising globally. While mortality from NSTIs has declined, variations in healthcare resources impact outcomes worldwide.
Area of Science:
- Infectious Diseases
- Global Health
- Microbiology
Background:
- Necrotizing soft tissue infections (NSTIs) present diverse patterns globally, influenced by local and environmental factors.
- Previous research lacked a comprehensive global survey of NSTI epidemiology and outcomes.
- This study addresses the need for a worldwide analysis of NSTI frequency, microbiology, and patient outcomes.
Purpose of the Study:
- To conduct a systematic review and meta-analysis of global necrotizing soft tissue infections.
- To investigate the prevalence of polymicrobial versus monomicrobial NSTIs worldwide.
- To analyze trends in microbial causes and overall mortality rates of NSTIs across different regions.
Main Methods:
- Systematic review and meta-analysis of 105 peer-reviewed studies (8,718 patients).
- Extraction of data on microbial etiology, infection site, and mortality from global sources.
- Statistical analysis including random-effects meta-analysis, sensitivity analysis, and meta-regression.
Main Results:
- Polymicrobial infections accounted for 53% of NSTIs, while monomicrobial infections represented 37.9%.
- Truncal NSTIs were predominantly polymicrobial, whereas extremity infections were more commonly monomicrobial.
- Staphylococcus aureus was the most frequent pathogen globally; Methicillin-resistant S. aureus (MRSA) comprised 16% of infections. Overall mortality was 23.1% but showed a declining trend.
Conclusions:
- While polymicrobial infections remain dominant, the global incidence of monomicrobial NSTIs is increasing.
- The observed decrease in NSTI-related mortality is a positive development, potentially linked to improved management strategies.
- Significant global disparities in healthcare resources may influence NSTI outcomes despite overall mortality trends.
More Related Videos
04:01Indocyanine Green-Guided Intraoperative Imaging to Facilitate Video-Assisted Retroperitoneal Debridement for Treating Acute Necrotizing Pancreatitis
Published on: September 8, 2022
06:51Author Spotlight: Enhancing Understanding and Treatment Strategies with the NEC-on-a-Chip Model
Published on: July 28, 2023
Related Concept Videos
01:16Necrosis
Morphological Manifestations of Necrosis
Necrotic cells show different types of morphological appearance depending on the type of tissue and infection. In coagulative necrosis, cells become...
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.
01:22Burn Injuries
The damage results in the death of skin cells, which can lead to a massive loss of fluid. Dehydration, electrolyte imbalance, and renal and circulatory failure follow, which can be fatal. Burn patients are treated with intravenous fluids to offset...