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Epidemiology of staphylococcal scalded skin syndrome in U.S. children
A Staiman1, D Y Hsu1, J I Silverberg1,2,3
1Departments of Dermatology.
Insights
Staphylococcal scalded skin syndrome (SSSS) incidence in U.S. children is increasing, particularly in infants. This condition is linked to sociodemographic factors and other infections, necessitating further research to reduce rising rates.
Area of Science:
- Pediatric Infectious Diseases
- Dermatology
- Epidemiology
Background:
- Staphylococcal scalded skin syndrome (SSSS) is a blistering skin condition caused by Staphylococcus aureus exfoliative toxins.
- Understanding SSSS epidemiology in children is crucial for public health initiatives.
Purpose of the Study:
- To determine the incidence, costs, length of stay (LOS), comorbidities, and mortality associated with SSSS in U.S. children.
- To identify demographic and clinical factors associated with SSSS in pediatric populations.
Main Methods:
- Analysis of the Nationwide Inpatient Sample (NIS) from 2008-2012, encompassing a 20% sample of U.S. hospitalizations.
- Inclusion of 589 pediatric SSSS cases in the analysis, utilizing multivariable logistic regression models.
Main Results:
- The mean annual incidence of SSSS was 7.67 per million U.S. children, with higher rates in infants under 2 years.
- SSSS prevalence increased over time and was associated with female sex, younger age groups, and winter/summer/autumn seasons.
- Hospitalizations for SSSS resulted in longer LOS and higher costs compared to controls, with similar inpatient mortality rates.
Conclusions:
- The prevalence of SSSS in U.S. children appears to be increasing, influenced by sociodemographic factors and co-occurring infections.
- Further research is recommended to validate these findings and develop strategies to mitigate the rising incidence of SSSS.
Background:
Staphylococcal scalded skin syndrome (SSSS) is a blistering dermatosis caused by exfoliative toxins released from Staphylococcus aureus.
Objectives:
To describe the incidence, costs, length of stay (LOS), comorbidities and mortality of SSSS in U.S. children.
Methods:
The Nationwide Inpatient Sample 2008-2012 was analysed, including a 20% sample of U.S. hospitalizations and 589 cases of SSSS.
Results:
The mean annual incidence of SSSS was 7·67 (range 1·83-11·88) per million U.S. children, with 45·1 cases per million U.S. infants age < 2 years. In multivariable logistic regression models, SSSS was significantly associated with the following (shown as adjusted odds ratio and 95% confidence interval): female sex (1·12, 1·00-1·25), age (2-5 years: 13·31, 11·82-14·99; 6-10 years: 2·93, 2·35-3·66; 11-17 years: 0·44, 0·31-0·63); race/ethnicity (black: 0·69, 0·58-0·84) and season (winter: 2·04, 1·66-2·50; summer: 3·47, 2·86-4·22; autumn: 3·04, 2·49-3·70), with increasing odds over time (2010-2011: 2·28, 2·07-2·51; 2012: 2·98, 2·69-3·30). The geometric mean (95% confidence interval) LOS and cost of hospitalization for patients with vs. without SSSS were 3·2 (3·0-3·4) vs. 2·4 (2·4-2·5) days and $4624·0 ($4250-$5030) vs. $1872 ($1782·7-$1965). Crude inpatient mortality rates (with 95% confidence intervals) were similar for children with vs. without SSSS (0·33%, 0·00-0·79% vs. 0·36%, 0·34-0·39%). SSSS was associated with other infections, including in the upper respiratory tract and skin.
Conclusions:
The prevalence of SSSS appears to be increasing over time, and was associated with a number of sociodemographic factors and other infections. Further studies are needed to confirm these findings and reduce rising rates of SSSS.
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