{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T18:15:20Z","timestamp":1778523320857,"version":"3.51.4"},"reference-count":42,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Necrotizing fasciitis (NF) is a rapidly progressing and life-threatening soft tissue infection. It commonly affects the extremities and is triggered by trauma, surgical wounds or compromised skin integrity. Although there have been advancements in diagnosis and treatment, NF continues to be a complex condition due to comorbidities and the wide range of involved pathogens. The aim of this study was to assess the epidemiology, risk factors, and outcomes of NF in Switzerland, focusing on the distinction between polymicrobial and monomicrobial infections and their associated management. Methods: This monocentric retrospective study analyzed 75 patients treated for intraoperatively confirmed NF from 2010 to 2022. Data collection included demographic and clinical variables, comorbidities, and laboratory results. Univariate and multivariate statistical tests were conducted to assess associations between mortality and different infection types. Results: NF was most commonly localized in the lower extremities (52% of cases). Nearly all patients (99%) had at least one comorbidity, with coronary heart disease, kidney disease, and liver disease being most frequently observed. Advanced age was associated with higher in-hospital mortality (OR (odds ratio) 3.80, p = 0.033, q = 0.500, 16 of 44 patients over 60 died), and the overall in-hospital mortality in the cohort was 27%. Kidney disease and smoking were associated with polymicrobial infections, with an OR of 6.60 (p = 0.016, q = 0.130) and 5.60 (p = 0.009, q = 0.130), respectively. Trauma was associated with monomicrobial streptococcal infections (OR 3.40, p = 0.029, q = 0.500), and showed a significant association with Streptococcus pyogenes infections (OR 8.10, p &lt; 0.001, q = 0.004). Conclusions: This study highlights advanced age, trauma, kidney disease and smoking as factors associated with worse outcomes and specific infection patterns in patients with NF. These findings, derived from a Swiss patient population, underscore the importance of early identification of high-risk individuals to improve clinical outcomes. Recognizing these risk profiles may support clinicians in prioritizing rapid escalation of care for the patients most likely to benefit from early and aggressive intervention.<\/jats:p>","DOI":"10.3390\/jcm15103689","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T17:17:42Z","timestamp":1778519862000},"page":"3689","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Necrotizing Fasciitis in Switzerland: Risk Factors and Clinical Outcomes Based on a 12-Year Retrospective Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Annina M. C.","family":"F\u00fcrer","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Bern, 3008 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Athanasios","family":"Papanikolaou","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Inselspital University Hospital, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihai","family":"Constantinescu","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Inselspital University Hospital, 3010 Bern, Switzerland"},{"name":"Department for BioMedical Research, Faculty of Medicine, University of Bern, 3008 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Parham","family":"Sendi","sequence":"additional","affiliation":[{"name":"Institute for Infectious Diseases, University of Bern, 3001 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s13017-016-0097-y","article-title":"Pattern and predictors of mortality in necrotizing fasciitis patients in a single tertiary hospital","volume":"11","author":"Jabbour","year":"2016","journal-title":"World J. Emerg. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1097\/TA.0b013e318232a6b3","article-title":"Necrotizing fasciitis: Classification, diagnosis, and management","volume":"72","author":"Lancerotto","year":"2012","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"35320","DOI":"10.52965\/001c.35320","article-title":"Necrotizing fasciitis of the upper extremity\u2014A review","volume":"14","author":"Ditsios","year":"2022","journal-title":"Orthop. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1378\/chest.110.1.219","article-title":"Necrotizing fasciitis","volume":"110","author":"Green","year":"1996","journal-title":"Chest"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1136\/jcp.40.3.335","article-title":"Streptococcal necrotising fasciitis: Comparison between histological and clinical features","volume":"40","author":"Barker","year":"1987","journal-title":"J. Clin. Pathol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Misiakos, E.P., Bagias, G., Patapis, P., Sotiropoulos, D., Kanavidis, P., and Machairas, A. (2014). Current concepts in the management of necrotizing fasciitis. Front. Surg., 1.","DOI":"10.3389\/fsurg.2014.00036"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Borschitz, T., Schlicht, S., Siegel, E., Hanke, E., and von Stebut, E. (2015). Improvement of a clinical score for necrotizing fasciitis: \u201cPain out of proportion\u201d and high CRP levels aid the diagnosis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0132775"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"679","DOI":"10.47102\/annals-acadmedsg.2025140","article-title":"Prognostic factors and outcomes of extremity necrotising fasciitis in Singapore","volume":"54","author":"Chua","year":"2025","journal-title":"Ann. Acad. Med. Singap."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1007\/s10039-015-0101-x","article-title":"Nekrotisierende Fasziitis der oberen Extremit\u00e4t: Diagnostik und Therapiealgorithmus","volume":"18","author":"Rahimi","year":"2016","journal-title":"Trauma Berufskrankh."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1097\/00000658-199611000-00011","article-title":"Necrotizing soft tissue infections: Risk factors for mortality and strategies for management","volume":"224","author":"Elliott","year":"1996","journal-title":"Ann. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"84186","DOI":"10.58616\/001c.84186","article-title":"Necrotizing fasciitis of the upper extremity: A systematic review of the literature","volume":"1","author":"Bilolikar","year":"2023","journal-title":"SurgiColl"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s13017-016-0080-7","article-title":"Review of 58 patients with necrotizing fasciitis in the Netherlands","volume":"11","author":"Bijker","year":"2016","journal-title":"World J. Emerg. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.jhin.2010.01.028","article-title":"Diagnosis and management of necrotising fasciitis: A multiparametric approach","volume":"75","author":"Morgan","year":"2010","journal-title":"J. Hosp. Infect."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s00256-013-1813-2","article-title":"Necrotizing fasciitis: An urgent diagnosis","volume":"43","author":"Lemercier","year":"2014","journal-title":"Skelet. Radiol."},{"key":"ref_15","first-page":"981","article-title":"Necrotizing fasciitis","volume":"55","author":"Puvanendran","year":"2009","journal-title":"Can. Fam. Physician"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.ijid.2023.04.390","article-title":"High mortality risk of type III monomicrobial gram-negative necrotizing fasciitis: The role of extraintestinal pathogenic Escherichia coli (ExPEC) and Klebsiella pneumoniae","volume":"132","author":"Cheng","year":"2023","journal-title":"Int. J. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e119","DOI":"10.1002\/bjs.9371","article-title":"Early diagnosis of necrotizing fasciitis","volume":"101","author":"Goh","year":"2014","journal-title":"Br. J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1089\/sur.2023.372","article-title":"Risk factors for mortality among patients with Fournier gangrene: A systematic review","volume":"25","author":"Shet","year":"2024","journal-title":"Surg. Infect."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1007\/s11605-020-04531-8","article-title":"Meleney\u2019s synergic gangrene","volume":"25","year":"2021","journal-title":"J. Gastrointest. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"526","DOI":"10.2106\/JBJS.19.00591","article-title":"Necrotizing fasciitis: Pillaging the acute phase response","volume":"102","author":"Hysong","year":"2020","journal-title":"J. Bone Jt. Surg."},{"key":"ref_21","first-page":"e37775","article-title":"Diagnostic and prognostic value of laboratory risk indicator for necrotizing fasciitis score","volume":"15","author":"Sharma","year":"2023","journal-title":"Cureus"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1056\/NEJMra1600673","article-title":"Necrotizing soft-tissue infections","volume":"377","author":"Stevens","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1007\/s00068-021-01706-z","article-title":"Prognostic factors for mortality in 123 severe cases of necrotizing fasciitis in 5 hospitals in the Netherlands between 2003 and 2017","volume":"48","author":"Knubben","year":"2022","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_24","first-page":"S757","article-title":"Risk factors and outcomes in patients with severe necrotizing fasciitis admitted to surgical intensive care unit: A retrospective cohort study from Pakistan","volume":"35","author":"Khan","year":"2023","journal-title":"J. Ayub Med. Coll. Abbottabad"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.jinf.2011.07.019","article-title":"Increasing incidence of necrotizing fasciitis in New Zealand: A nationwide study over the period 1990 to 2006","volume":"63","author":"Das","year":"2011","journal-title":"J. Infect."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2580","DOI":"10.1007\/s00268-020-05559-2","article-title":"A 16-year longitudinal cohort study of incidence and bacteriology of necrotising fasciitis in England","volume":"44","author":"Bodansky","year":"2020","journal-title":"World J. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3067","DOI":"10.1007\/s00405-018-5155-5","article-title":"Clinical classification of cervical necrotizing fasciitis","volume":"275","author":"Amponsah","year":"2018","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2919","DOI":"10.1007\/s00268-020-05581-4","article-title":"Necrotizing fasciitis: A predictable burden in rural Kenya","volume":"44","author":"Lunar","year":"2020","journal-title":"World J. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.annder.2020.08.056","article-title":"Risk factors associated with necrotizing fasciitis of the lower limbs: A multicenter case-control study","volume":"148","author":"Diatta","year":"2021","journal-title":"Ann. Dermatol. V\u00e9n\u00e9r\u00e9ologie"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.bjid.2013.08.003","article-title":"Necrotizing fasciitis: Eight-year experience and literature review","volume":"18","author":"Wang","year":"2014","journal-title":"Braz. J. Infect. Dis."},{"key":"ref_31","first-page":"1692","article-title":"Necrotizing fasciitis: A comparative analysis of 56 cases","volume":"97","author":"Legbo","year":"2005","journal-title":"J. Natl. Med. Assoc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s00104-017-0397-0","article-title":"Nekrotisierende Fasziitis der oberen und unteren Extremit\u00e4t","volume":"88","author":"Hirsch","year":"2017","journal-title":"Chirurg"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1097\/01.sap.0000244978.27053.08","article-title":"Prognostic factors in necrotizing fasciitis and myositis: Analysis of 16 consecutive cases at a single institution in Switzerland","volume":"58","author":"Rieger","year":"2007","journal-title":"Ann. Plast. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1093\/cid\/ciy1011","article-title":"High mortality of non-Fournier necrotizing fasciitis with Enterobacteriales: Time to rethink classification?","volume":"69","author":"Kuehl","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_35","first-page":"467","article-title":"Independent predictors of mortality for necrotizing fasciitis: A retrospective analysis in a single institution","volume":"71","author":"Huang","year":"2011","journal-title":"J. Trauma"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1093\/intimm\/dxaa052","article-title":"Overcoming immune dysfunction in the elderly: Trained immunity as a novel approach","volume":"32","author":"Bulut","year":"2020","journal-title":"Int. Immunol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1017\/S0029665112000158","article-title":"The impact of obesity on the immune response to infection","volume":"71","author":"Milner","year":"2012","journal-title":"Proc. Nutr. Soc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3319","DOI":"10.1007\/s00068-024-02638-0","article-title":"Is overweight a predictor for a more severe course of disease in cases of necrotizing fasciitis?","volume":"50","author":"Illg","year":"2024","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_39","unstructured":"Diabetes Research Institute Foundation (2024, November 07). Diabetes Statistics. Available online: https:\/\/diabetesresearch.org\/diabetes-statistics\/."},{"key":"ref_40","unstructured":"Bundesamt f\u00fcr Statistik (BFS) (2024, November 07). Diabetes. Available online: https:\/\/www.bfs.admin.ch\/bfs\/de\/home\/statistiken\/gesundheit\/gesundheitszustand\/krankheiten\/diabetes.html."},{"key":"ref_41","unstructured":"Bundesamt f\u00fcr Statistik (BFS) (2024, November 07). \u00dcbergewicht. Available online: https:\/\/www.bfs.admin.ch\/bfs\/de\/home\/statistiken\/gesundheit\/determinanten\/uebergewicht.html."},{"key":"ref_42","unstructured":"Centers for Disease Control and Prevention (CDC) (2024, November 07). Adult Obesity Facts, Available online: https:\/\/www.cdc.gov\/obesity\/adult-obesity-facts\/."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3689\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T17:44:05Z","timestamp":1778521445000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3689"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,11]]},"references-count":42,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15103689"],"URL":"https:\/\/doi.org\/10.3390\/jcm15103689","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,11]]}}}