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

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.

Necrotizing fasciitis: an update on epidemiology, diagnostic methods, and treatment

“…It's worth noting that European countries such as the Netherlands, tend to have lower prevalence rates (ranging between 1.1 and 1.4 cases per 100 000 person-years) [7]. Conversely, countries with warmer climates like Thailand report rates as high as 32.64 cases per 100 000 person-years [8]. This correlation between NSTIs and warmer climates is well described in the literature [9].…”

“…In a recent study conducted in the USA, a mortality rate of 14.8% was recorded among 447 patients with surgically confirmed NSTIs [13 & ]. Additionally, encouraging data from Thailand reported mortality rates as low as 4.8% [8].…”

Necrotizing fasciitis in Indonesian adult with diabetes mellitus: Two case and review article

“…Necrotizing fasciitis (NF) is a life-threatening form of infection involving rapidly spreading inflammation and extensive necrosis of the skin, subcutaneous tissue, and superficial fascia with or without overlying cellulitis [1] . NF is a rare soft tissue infection and the incidence of NF in the world range from 0.30 to 15 cases per 100,000 people [2] . Delayed diagnosis and treatment for NF may contribute to extremely high mortality [3] .…”