Epidemiological Predisposing Factors Associated with Bacterial Necrotizing Fasciitis in Rural Thailand: a Case-Control Study

Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infection with a high mortality rate. Identifying the predisposing factors for NF is critical for enabling diagnosis and medical treatment. This study aimed to identify the factors associated with NF in a hospital located in rural Thailand. In total, 167 NF and 147 cellulitis cases were compared between 2019 and 2021. Among the NF cases, 13.17% required amputation and 7.69% were fatal. The study identified male sex, farming occupation, Streptococcus pyogenes infection, and comorbidities, including diabetes mellitus (DM), chronic kidney disease, and hypertension, as significant predisposing factors for NF. DM was statistically significantly associated with an increased risk of amputation. For pathogen-specific NF, advanced age (≥60 years) was the only statistically significant predisposing factor for S. pyogenes-associated NF. Conversely, NF caused by Staphylococcus aureus is significantly associated with farming occupation, DM, and hypertension. For NF caused by Enterobacterales, male sex, farming occupation, DM, and chronic kidney disease were statistically significant predisposing factors. These may not be risk factors that can be generalized, but may be the only risk factors for NF in Thailand. However, these findings may inform the development of guidelines for nursing care and pathogen-specific prevention of NF.