Increasing national burden of hospitalizations for skin and soft tissue infections in children

Lautz, Timothy B.; Raval, Mehul V.; Barsness, Katherine A.

doi:10.1016/j.jpedsurg.2011.05.008

Cited by 43 publications

(40 citation statements)

References 14 publications

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“…For example, a recent U.S. study showed that in 2000, there were 17,525 Ϯ 838 admissions for SSTI, which represented 0.65% of all pediatric hospitalizations and corresponded to a rate of 23.2 SSTI hospitalizations per 100,000 children per year. However, by 2006, there were 48,228 Ϯ 2,223 admissions for SSTI, which represented 1.77% of all pediatric hospitalizations and corresponded to a rate of 62.7 SSTI hospitalizations per 100,000 children per year (22). In our study, we also found an increase in antibiotic use over time, but it was not as dramatic as those seen in the U.S. populations.…”

Section: Discussionsupporting

confidence: 39%

Population-Based Study of the Increased Incidence of Skin and Soft Tissue Infections and Associated Antimicrobial Use

Marra

Patrick

Chong

et al. 2012

Antimicrob Agents Chemother

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b Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has spread rapidly throughout the world in the last decade. We sought to demonstrate the impact of the emergence of CA-MRSA in Western Canada on physician visits, incision-and-drainage procedures, and antibiotic prescribing for skin and soft tissue infections (SSTI). We used the provincial physician billing system to determine the rate of physician visits (per 1,000 population per year) of SSTI and incision-and-drainage procedures. A database capturing all outpatient prescriptions in the province was anonymously linked to associated physician billing codes to quantify prescriptions associated with SSTI. Antibiotic prescriptions (overall and class specific) were expressed as their defined daily dose (DDD) per 1,000 inhabitants per day. Between 1996 and 2008, the rate of visits for all SSTI increased by 15%, and the majority of visits did not include an incision-and-drainage procedure. The rate of antibiotic prescribing for SSTI increased by 49%. The majority of this increase was attributable to the higher rates of use of clindamycin (627%), trimethoprim-sulfamethoxazole (380%), cephalosporins (160%), and amoxicillin-clavulanate (627%). Health care utilization and antibiotic prescribing rates for SSTI, but not incision-anddrainage procedures, have increased in association with the CA-MRSA epidemic. While much of the increase in antibiotic use reflects an appropriate change to trimethoprim-sulfamethoxazole, there is room for education regarding the limitations of cephalosporins and clindamycin, given current susceptibility profiles.

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Section: Discussionsupporting

confidence: 39%

Population-Based Study of the Increased Incidence of Skin and Soft Tissue Infections and Associated Antimicrobial Use

Marra

Patrick

Chong

et al. 2012

Antimicrob Agents Chemother

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“…Similar to previously published studies on SSTIs, our study used ICD-9 codes to identify potential subjects. 1,2,12,13 See online Supplemental Appendix 1 for inclusion and exclusion ICD-9 diagnosis, procedure, and Current Procedural Terminology codes. To minimize misclassification, we reviewed the charts of all included patients with primary ICD-9 for SSTI as well as a random sample of 20% of the patients with a secondary ICD-9 for SSTI.…”

Section: Population and Data Sourcementioning

confidence: 99%

“…1,2 Although recent national guidelines for SSTIs have evaluation and treatment recommendations in children and adults, 3 young infants with SSTI represent a unique challenge to the clinician. Infants #90 days of age who present with fever without a source are often evaluated for urinary tract infection (UTI) and invasive bacterial infection (IBI) because the rate of UTI/IBI in this age group can reach 8% to 17% even if the infant is wellappearing.…”

mentioning

confidence: 99%

Outcomes After Skin and Soft Tissue Infection in Infants 90 Days Old or Younger

Hester

Hersh

Mundorff

et al. 2015

Hospital Pediatrics

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A B S T R A C T BACKGROUND AND OBJECTIVES:Skin and soft tissue infections (SSTIs) are an increasingly common cause of pediatric hospital visits among infants. The optimal evaluation strategy for younger infants with SSTI is unknown because there is little information about outcomes including risks of concomitant bacterial infections and treatment failure. This study was designed to determine rates of concomitant invasive bacterial infection and hospital revisits for treatment failure as well as factors associated with treatment failure in infants presenting with SSTI. METHODS:Retrospective study of patients #90 days of age who received care from the 22 emergency departments and hospitals in the Intermountain Healthcare system from July 1, 2004 to December 31, 2011, with a primary discharge diagnosis of SSTI. Concomitant bacterial infections were defined as urinary tract infection (UTI; culture-confirmed) or invasive bacterial infection (IBI; culture-confirmed bacteremia and/or meningitis). Treatment failure was defined as any unplanned change in care at hospital revisit within 14 days of discharge. RESULTS:The study included 172 infants; 29 (17%) were febrile, and 91 (53%) had $1 sterile site culture performed. One case of bacteremia in a febrile infant was identified giving an overall proportion with UTI/IBI of 0.58% (95% confidence interval 0.01%-3.2%). Sixteen infants (9.3%; 95% confidence interval 5.4%-14.7%) returned for treatment failure. Perianal location (P 5 .03) and private insurance status (P 5 .01) were associated with more treatment failures compared with other locations or payer types. No patients returned for missed UTI/IBI. CONCLUSIONS:Concomitant bacterial infections were rare in infants with SSTI, with none identified in afebrile infants. Treatment failure of SSTI leading to hospital revisit was common.

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“…Hospitalizations for pediatric SSTI accounted for 1% of all hospitalizations in a recent review of the Kids' Inpatient Data Base by Lopez et al 2 Using the same data base, Lautz et al reported that hospital admissions for SSTIs in children increased by about 44% from 2003 to 2006. 3 With regard to estimating the volume of pediatric open wounds and burns, the literature is limited. Again, the Kids' Inpatient Data Base captures admissions for open wounds while limited cases of firearm wounds and burns can be found in databases such as the Healthcare Cost and Utilization Project and American Burn Association National Burn Repository.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6][7] Lautz et al estimated the in-hospital cost of caring for an SSTI to be between $3,521 and $4,296 per patient. 3 The care for SSTIs and wounds in children can often involve surgical intervention and ongoing wound care. In 2009, the incidence of incision and drainage procedures for SSTIs increased from 21% to 44%, as reported by Lopez et al 2 Limited data exist for the cost associated with care of other skin and soft tissue wounds sustained by children, including traumatic wounds.…”

Section: Introductionmentioning

confidence: 99%

Complex pediatric wound care with a dedicated pediatric wound care service: a review of our 12-year experience

Bernabe¹

2016

CWCMR

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Pediatric skin and soft tissue infections and wounds are on the rise. The effects of this increase are being felt in the emergency department and inpatient hospital settings. The costs associated with evaluation and management of children with surgical wounds and soft tissue infections are not insignificant. This is a review of our single institutional experience with delivery of wound care for the increasing pediatric skin infection and wound population utilizing a specific model for the past 12 years. It is especially tailored for complex pediatric wounds that would otherwise be cared for in the operating room setting.

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Increasing national burden of hospitalizations for skin and soft tissue infections in children

Cited by 43 publications

References 14 publications

Population-Based Study of the Increased Incidence of Skin and Soft Tissue Infections and Associated Antimicrobial Use

Population-Based Study of the Increased Incidence of Skin and Soft Tissue Infections and Associated Antimicrobial Use

Outcomes After Skin and Soft Tissue Infection in Infants 90 Days Old or Younger

Complex pediatric wound care with a dedicated pediatric wound care service: a review of our 12-year experience

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