A study on the situation of necrotizing fasciitis in Thailand, 2018

Abstract

Backgrounds: Necrotizing fasciitis (NF), a serious skin and soft tissue bacterial infection, can cause severe complications, including amputation and death. In Thailand, the nationwide situation of NF has never been investigated. The objectives of this study are to assess the magnitude and distributions by time, place and person of NF and to provide recommendations and control measures.
Methods: This was a cross–sectional study using secondary data extracted from Health Data Center (HDC) database. Study population include all patients diagnosed as NF (ICD–10: M72.6) from 1st January–31st December 2018. The data were analyzed using percentage and median (with interquartile range). Spatial pattern was tested by Moran’s I statistic and local Moran’s I test map.
Results: In 2018, there were 19,071 NF cases (incidence rate 31.1 per 100,000 population). Monthly incidence proportions are highest between May and August, which is crop planting season. Male to female ratio was 1.5:1. Median age was 59.7 years old. Most of the cases worked in elementary occupations (32.7%) and skilled agriculture ( 32.1%). The patients most likely developed NF at ankle and foot (43.0%) followed by lower leg (28.2%). The amputation rate among the cases was 8.2%; while, case–fatality rate was 6.3%. There were 11,813 cases having underlying diseases before developing NF; most of them had hypertension (72.2%) and diabetes mellitus (68.3%). Both Moran’s I statistic of 0.54 (p–value < 0.01) and local Moran’s I test map indicated a cluster pattern in the upper northeastern Thailand, where most local people work in agricultural sector.
Conclusions and discussions: NF causes significant morbidity and mortality in Thailand. Occurrence of NF is highly seasonal and clustered in the upper northeastern Thailand. Health education should be given to people living in the high–risk area especially the elderly or patients with chronic diseases. Early antibiotics treatment and a close follow–up should be done among the high–risk patients with skin infection in order to reduce NF–related disability and mortality.