Epidemiological Situation of Necrotizing Fasciitis and Factors in Thailand and Factors Associated with Its Morbidity and Mortality, 2014–2018

Abstract

Introduction

Necrotizing fasciitis (NF) is a rare skin and soft-tissue bacterial infection with high morbidity and mortality. Knowledge about the prevalence and incidence of NF in Thailand is quite sparse. The objective of this study was to determine the prevalence of NF in Thailand and factors that may be potentially associated with NF morbidity and mortality.

Methods

A cross-sectional study using secondary data from Thailand’s national health databases between 2014 and 2018 was conducted. Descriptive statistics using median and percentage formats were used. This was complemented by multivariable logistic regression to determine the association between various factors (such as age and underlying diseases) with NF morbidity and mortality. Univariate spatial data analysis was exercised to identify the geographical hot spots in which the disease appeared.

Results

During 2014–2018, we found 90,683 NF cases. About 4.86% of the cases died. The median age for all cases was 59.39 years old. The annual incidence of NF demonstrated an upward trend (from 26.08 per 100,000 population in 2014 to 32.64 per 100,000 population in 2018). The monthly incidence was highest between May and August. A high incidence cluster (as indicated by local Moran’s I) was found in the north-eastern region of Thailand. The most infected sites were on the ankles and feet (43.18%) with an amputation rate of 7.99% in all cases. Multivariable logistic regression indicated that the significant risk factor for amputation was a presence of underlying diseases, namely diabetes (OR 7.94, 95% CI 7.34–8.61). Risk factors for mortality included being elderly (OR 1.82, 95% CI 1.68–1.98) and a presence of underlying hypertension (OR 1.16, 95% CI 1.07–1.27), cirrhosis (OR 4.67, 95% CI 4.17–5.21), and malignancy (OR 1.88, 95% CI 1.55–2.26).

Discussion and Conclusion

As the elderly and those with chronic underlying diseases are likely to face non-preferable health outcomes from NF, healthcare providers should pay great attention to these groups of patients. Early and intensive treatment might be considered in these groups of patients. Further studies that aim to validate the volume of actual NF cases and reported NF cases are recommended.

Keywords:

• necrotizing fasciitis
• incidence
• mortality
• morbidity

Acknowledgments

Open Access funding provided by the Qatar National Library. The authors thank the Health Data Center (HDC) and Information and Communication Technology Center of the Office of the Permanent Secretary in providing the data. Funding for publication was supported by IHPP.

Ethical Consideration

As this study is part of the routine monitoring system of the Thai DDC and only secondary data were used, no ethical clearance is necessary. However, in this study, the researchers strictly followed ethical standards in research, that is, all individual information was strictly kept confidential and not reported in the paper.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest for this work.

Additional information

Funding

This project was funded by the Field Epidemiology Training Program (FETP), Division of Epidemiology, Department of Disease control, Ministry of Public Health, Thailand. Funding for publication was supported by International Health Policy Program (IHPP), Ministry of Public Health, Thailand.