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Published on: February 9, 2011
Association between skin diseases and severe bacterial infections in children: case-control study
Robbert S A Mohammedamin1, Johannes C van der Wouden, Sander Koning
1Department of General Practice, Room FF 304, Erasmus MC-University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. s.mohammedamin@erasmusmc.nl
Insights
Children with sepsis or bloodstream infections (bacteraemia) more often saw a general practitioner (GP) for skin conditions. However, this association was not clinically significant, limiting opportunities for GPs to prevent sepsis by managing skin diseases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Dermatology
Background:
- Sepsis and bloodstream infections (bacteraemia) are rare but serious conditions in children, associated with high mortality.
- Previous research suggests a link between skin diseases and an increased risk of sepsis or bacteraemia in children.
- This study investigates whether children with sepsis/bacteraemia present more frequently with skin conditions to general practitioners (GPs).
Purpose of the Study:
- To determine if children diagnosed with sepsis or bacteraemia have a higher incidence of skin-related consultations with general practitioners (GPs) compared to control groups.
- To assess the potential for GPs to mitigate sepsis risk through appropriate management of pediatric skin diseases.
Main Methods:
- A case-control study utilizing data from a Dutch national survey of general practice and hospital admissions (2001).
- Cases included children aged 0-17 hospitalized for sepsis or bacteraemia.
- Two control groups were established: one from GP patient lists and another from children hospitalized for non-sepsis reasons.
Main Results:
- Children with sepsis/bacteraemia showed a statistically significant higher odds of skin-related GP consultations (OR 3.4) compared to GP controls, but not hospital controls (OR 1.4).
- Infants under three months had higher odds ratios for skin-related consultations, though not reaching statistical significance.
- Despite more frequent skin consultations, only 5% of sepsis cases involved a GP visit for a skin condition, indicating low clinical relevance.
Conclusions:
- While children with sepsis/bacteraemia do consult GPs more often for skin diseases, the association lacks clinical significance.
- The findings suggest limited potential for GPs to substantially reduce sepsis and/or bacteraemia risk by focusing on the management of pediatric skin diseases.
Background:
Sepsis or bacteraemia, however rare, is a significant cause of high mortality and serious complications in children. In previous studies skin disease or skin infections were reported as risk factor. We hypothesize that children with sepsis or bacteraemia more often presented with skin diseases to the general practitioner (GP) than other children. If our hypothesis is true the GP could reduce the risk of sepsis or bacteraemia by managing skin diseases appropriately.
Methods:
We performed a case-control study using data of children aged 0-17 years of the second Dutch national survey of general practice (2001) and the National Medical Registration of all hospital admissions in the Netherlands. Cases were defined as children who were hospitalized for sepsis or bacteraemia. We selected two control groups by matching each case with six controls. The first control group was randomly selected from the GP patient lists irrespective of hospital admission and GP consultation. The second control group was randomly sampled from those children who were hospitalized for other reasons than sepsis or bacteraemia. We calculated odds ratios and 95% confidence intervals (CI). A two-sided p-value less than 0.05 was considered significant in all tests.
Results:
We found odds ratios for skin related GP consultations of 3.4 (95% CI: [1.1-10.8], p = 0.03) in cases versus GP controls and 1.4 (95% CI: [0.5-3.9], p = 0.44) in cases versus hospital controls. Children younger than three months had an odds ratio (cases/GP controls) of 9.2 (95% CI: [0.81-106.1], p = 0.07) and 4.0 (95% CI: [0.67-23.9], p = 0.12) among cases versus hospital controls. Although cases consulted the GP more often with skin diseases than their controls, the probability of a GP consultation for skin disease was only 5% among cases.
Conclusion:
There is evidence that children who were admitted due to sepsis or bacteraemia consulted the GP more often for skin diseases than other children, but the differences are not clinically relevant indicating that there is little opportunity for GPs to reduce the risk of sepsis and/or bacteraemia considerably by managing skin diseases appropriately.
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