Factors Associated with Disability and Mortality among Necrotizing Fasciitis Patients in Thailand, 2018

Authors

  • Hirunwut Praekunatham Division of Occupational and Environmental Diseases, Department of Disease Control, Ministry of Public Health, Thailand
  • Panupong Tantirat Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand

DOI:

https://doi.org/10.59096/osir.v13i1.262850

Keywords:

necrotizing fasciitis, NF, disability, mortality, risk factor

Abstract

Necrotizing fasciitis (NF) is a serious skin and soft tissue infection that can lead to disabilities and mortalities. A study was carried out to describe demographic characteristics of NF patients, and determine factors associated with disability and mortality. Information on all patients who were diagnosed as NF from 1 Jan to 31 Dec 2018 were extracted from the databases of Health Data Center in Thailand. Univariate and multivariate analyses using logistic regression were performed to determine the associated factors. In 2018, of total 19,071 NF cases, 6.3% died. Median age was 59.7 years old (Q1-Q3 = 49.1-69.5 years). Most of the cases developed NF at ankle and foot (43.0%), followed by lower leg (28.2%). The amputation rate among the cases was 8.2%. Multivariable analysis showed the significant risk factor for amputation as having diabetes mellitus (adjusted OR 6.81, 95% CI 5.97-7.77). Risk factors for mortality included being elderly (OR 1.81, 95% CI 1.56-2.11), and having hypertension (OR 1.17, 95% CI 1.00-1.36), cirrhosis (OR 4.26, 95% CI 3.42-5.28) or cancer (OR 1.88, 95% CI 1.33-2.59). Morbidity and mortality among NF patients were significant in Thailand. Health workers should be trained for early diagnosis and intensive treatment for NF, especially among elderly and patients with chronic diseases in order to prevent the subsequent complications.

References

Shaikh N, Khawaiter J, Al-Thani H. Necrotizing fasciitis: a surgical and medical emergency. Surgical Science. 2012; Vol.03No.11:8.

Puvanendran R, Huey JCM, Pasupathy S. Necrotizing fasciitis. Can Fam Physician. 2009;55(10):981-7.

Headley AJ. Necrotizing soft tissue infections: a primary care review. American family physician. 2003;68(2):323-8.

Eneli I, Davies HD. Epidemiology and outcome of necrotizing fasciitis in children: an active surveillance study of the Canadian Paediatric Surveillance Program. The Journal of pediatrics. 2007;151(1):79-84, e1.

Naseer U, Blystad H, Angeloff L, Nygård K, Vold L, Macdonald E. Cluster of septicaemia and necrotizing fasciitis following exposure to high seawater temperatures in southeast Norway, June to August 2018. International Journal of Infectious Diseases. 2019; 79:28.

Mulla ZD, Gibbs SG, Aronoff DM. Correlates of length of stay, cost of care, and mortality among patients hospitalized for necrotizing fasciitis. Epidemiol Infect. 2007;135(5):868-76.

Malheiro LF, Magano R, Ferreira A, Sarmento A, Santos L. Skin and soft tissue infections in the intensive care unit: a retrospective study in a tertiary care center. Rev Bras Ter Intensiva. 2017;29(2):195-205.

Khamnuan P, Chongruksut W, Jearwattanakanok K, Patumanond J, Tantraworasin A. Necrotizing fasciitis: epidemiology and clinical predictors for amputation. Int J Gen Med. 2015; 8:195-202.

Ahn J, Raspovic KM, Liu GT, Lavery LA, La Fontaine J, Nakonezny PA, et al. Lower extremity necrotizing fasciitis in diabetic and nondiabetic patients: mortality and amputation. The international journal of lower extremity wounds. 2019;18(2):114-21.

Cheng N-C, Tai H-C, Chang S-C, Chang C-H, Lai H-S. Necrotizing fasciitis in patients with diabetes mellitus: clinical characteristics and risk factors for mortality. BMC Infect Dis. 2015; 15:417-.

Huysman E, Mathieu C. Diabetes and peripheral vascular disease. Acta chirurgica Belgica. 2009;109(5):587-94.

Thiruvoipati T, Kielhorn CE, Armstrong EJ. Peripheral artery disease in patients with diabetes: epidemiology, mechanisms, and outcomes. World J Diabetes. 2015;6(7):961-9.

Carey IM, Critchley JA, DeWilde S, Harris T, Hosking FJ, Cook DG. Risk of infection in type 1 and type 2 diabetes compared with the general population: a matched cohort study. Diabetes Care. 2018;41(3):513.

Casqueiro J, Casqueiro J, Alves C. Infections in patients with diabetes mellitus: A review of pathogenesis. Indian J Endocrinol Metab. 2012;16 Suppl 1(Suppl1): S27-S36.

Brem H, Tomic-Canic M. Cellular and molecular basis of wound healing in diabetes. J Clin Invest. 2007;117(5):1219-22.

Dangwal S, Stratmann B, Bang C, Lorenzen JM, Kumarswamy R, Fiedler J, et al. Impairment of wound healing in patients with type 2 diabetes mellitus influences circulating microRNA patterns via inflammatory cytokines. Arterioscler Thromb Vasc Biol. 2015;35(6):1480-8.

Awsakulsutthi S. A retrospective review of necrotizing fasciitis in Thammasat University Hospital. Journal of the Medical Association of Thailand = Chotmaihet thangphaet. 2010;93 Suppl 7: S246-53.

Dworkin MS, Westercamp M, Park L, McIntyre A. The epidemiology of necrotizing fasciitis including factors associated with death and amputation. Epidemiol Infect. 2009; 137:1609-14.

Khamnuan P, Chongruksut W, Jearwattanakanok K, Patumanond J, Yodluangfun S, Tantraworasin A. Necrotizing fasciitis: risk factors of mortality. Risk Manag Healthc Policy. 2015; 8:1-7.

Castelo-Branco C, Soveral I. The immune system and aging: a review. Gynecological endocrinology: the official journal of the International Society of Gynecological Endocrinology. 2014;30(1):16-22.

Malaguarnera L, Cristaldi E, Malaguarnera M. The role of immunity in elderly cancer. Critical reviews in oncology/hematology. 2010;74(1):40-60.

Opal SM, Girard TD, Ely EW. The immunopathogenesis of sepsis in elderly patients. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2005;41 Suppl 7: S504-12.

Noor MT, Manoria P. Immune dysfunction in cirrhosis. J Clin Transl Hepatol. 2017;5(1):50-8.

Oud L, Watkins P. Necrotizing fasciitis among patients with liver cirrhosis in Texas, 2001 - 2010: a population-based cohort study. J Clin Med Res. 2016;8(2):90-6.

Buford TW. Hypertension and aging. Ageing Res Rev. 2016; 26:96-111.

Sun Z. Aging, arterial stiffness, and hypertension. Hypertension. 2015;65(2):252-6.

Axelrad H, Malul M, Luski I. Unemployment among younger and older individuals: does conventional data about unemployment tell us the whole story? J Labour Mark Res. 2018;52(1):3-.

Janlert U. Unemployment as a disease and diseases of the unemployed. Scandinavian Journal of Work, Environment & Health. 1997; 23:79-83.

Doku DT, Acacio-Claro PJ, Koivusilta L, Rimpelä A. Health and socioeconomic circumstances over three generations as predictors of youth unemployment trajectories. European Journal of Public Health. 2018;29(3):517-23.

de Glanville WA, Thomas LF, Cook EAJ, Bronsvoort BMdC, Wamae NC, Kariuki S, et al. Household socio-economic position and individual infectious disease risk in rural Kenya. Scientific Reports. 2019;9(1):2972.

Published

2020-03-30

How to Cite

Praekunatham, H., & Tantirat, P. (2020). Factors Associated with Disability and Mortality among Necrotizing Fasciitis Patients in Thailand, 2018. Outbreak, Surveillance, Investigation & Response (OSIR) Journal, 13(1), 9–16. https://doi.org/10.59096/osir.v13i1.262850

Issue

Section

Original article