Necrotizing Fasciitis in the Kimberley: A Five-Year Retrospective Study From a Remote Australian Health Service

TL;DR

This study examines the high rate of a severe infection called necrotizing fasciitis in a remote Australian region and highlights challenges in diagnosis and treatment.

Contribution

The study provides new insights into the epidemiology and management of necrotizing fasciitis in a remote Australian setting.

Findings

The incidence of necrotizing fasciitis in the Kimberley was 12 per 100,000 population over five years.

Aboriginal and Torres Strait Islander people were disproportionately affected, with 76% of cases.

Common risk factors included diabetes, obesity, and smoking, with a 9% in-hospital mortality rate.

Abstract

Background

Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening infection with significant morbidity and mortality. Rural and remote regions face unique challenges in the timely diagnosis and management of NF.

Methodology

This retrospective study included all patients diagnosed with NF in the Kimberley region, Western Australia, between June 2020 and June 2025. Data were extracted from medical and surgical records, microbiology databases, and theater logs. Demographic, clinical, microbiological, and outcome variables were analyzed descriptively.

Results

In total, 21 patients were identified during the five-year period. The estimated incidence rate was 12 per 100,000 population. The median age was 49 years (interquartile range = 37-56); 8 (38%) were males, and 13 (62%) were females. Overall, 16 (76%) identified as Aboriginal and/or Torres Strait Islander. Diabetes (76%, 16), obesity (86%, 18), and smoking (62%, 13) were common. The most frequent site of infection was the lower limb, accounting for 52% (11) of cases, followed by the gluteal or buttock in 24% (5). All patients underwent operative management, and 9% (2) of patients died in the hospital.

Conclusions

The incidence of NF in the Kimberley is higher than the national and international average. This presents unique diagnostic and management challenges due to geographic remoteness, workforce shortages, and comorbidity burden. This study contributes valuable insights into the regional epidemiology and the management of NF in rural settings.