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‘Remarkable’ decline of skin and soft tissue infections seen in US EDs

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June 27, 2018

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Ethan Morgan

Researchers noted a “remarkable” decline in the incidence of skin and soft tissue infections, or SSTIs, in United States EDs between 2009 and 2014 following a sharp increase over the preceding years.

According to Ethan Morgan, PhD, postdoctoral research fellow in the Institute for Sexual and Gender Minority Health and Wellbeing at Northwestern University, and colleagues, the incidence of SSTIs in the U.S. increased sharply in hospitals and among outpatients after the year 2000, coinciding with a sharp increase in community-associated MRSA infections.

However, “We noticed that there was a decline in the number of patients visiting our ED with uncomplicated SSTIs after 2012,” they wrote in Clinical Infectious Diseases. “We therefore examined temporal trends in rate of SSTIs among ED patients in 2009-2014 at 86 U.S. academic medical centers.”

Morgan and colleagues analyzed data for ED encounters involving patients with SSTIs and calculated the rate per 1,000 ED encounters per year, stratified by SSTI or HIV, or both.

Among 25,239,781 ED visits in the years 2009 through 2014, there were 47,317 HIV-associated and 820,440 SSTI-associated patient encounters. The rate of SSTIs decreased 8% among all patients and 14.6% in patients with HIV. There was an overall decrease in SSTI incidence from 32 per 1,000 ED encounters to 29.7 per 1,000 ED encounters during the study period (RR = 0.98; 95% CI, 0.98-0.98) — “a remarkable epidemiologic shift,” Morgan and colleagues wrote.

The researchers reported that there were significantly higher rates of SSTIs in patients with HIV (51.9 SSTI-related encounters per 1,000 ED encounters) vs. patients without HIV (32.5 SSTI-related encounters per 1,000 ED encounters; adjusted RR = 1.91; 95% CI, 1.84-1.99).

“After a swift rise in the late '90s and early '00s due to MRSA, our study suggests the rate of SSTIs is generally on the decline in U.S. emergency departments, although people living with HIV continue to experience SSTIs at a higher rate than those uninfected with HIV,” Morgan told Infectious Disease News.

“One possibility is that men who have sex with men, the group most affected by HIV, and other at-risk populations are at unique risk for SSTIs. A second possibility is that community-associated MRSA moves more easily through the networks of these individuals, SSTIs being the most frequent form these infections take.” – by Bruce Thiel

Disclosures: Morgan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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