Publication date: Jun 04, 2025

During the COVID-19 pandemic restrictions such as social distancing, lockdowns and mask mandates were imposed by Germany’s government. After these interventions were abolished, an increase in group A streptococcal infections, including necrotizing fasciitis, was observed in our Level 1 trauma center. The aim of this study was to evaluate the incidence of type I and type II necrotizing fasciitis (NF) before, during and after the COVID-19 pandemic. 165 patients with severe NF, treated in our Level 1 trauma center, were included between 2010 and 2023. Patients were categorized into a pre-mask, mask and post-mask group, according to their date of admission relative to the COVID-19 pandemic. Clinical parameters and patient characteristics were assessed between groups. In the pre-mask group, type I NF (69%) was more common than type II NF (31%). In the mask group 95% of patients had type I NF. In the post-mask group, Streptococcus pyogenes triggered type II NF dominated with 74% of all cases. There was a significant increase in NF type II cases in the post-mask group compared to the pre-mask and mask-group (p 

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