October 28, 2019
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SSTI incidence plateaus overall in US, declines in children

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Following a “dramatic” rise in skin and soft tissue infections, or SSTIs, in the United States that peaked earlier this decade, evidence shows an overall plateau in more recent years and a decline among children, although the burden remains substantial, researchers reported.

“Anecdotally from clinical practice, as well as several recent studies suggest that the incidence of SSTIs has plateaued and in some scenarios has declined,” Stephanie A. Fritz, MD, MSCI, associate professor of pediatrics in the division of infectious diseases and co-director of the pediatric ID fellowship program at Washington University School of Medicine, told Infectious Disease News.

Fritz noted a 2008 study in which Hersh and colleagues assessed the annual incidence of ambulatory visits for purulent SSTI between 1997 and 2005 and found that there was an increase from 4.6 million to 9.6 million.

“We wanted to determine the trends in these settings for SSTI incidence since this previous time frame,” Fritz said.

Fritz and colleagues assessed a nationally representative sample of patient visits to physician offices and emergency departments using the National Hospital Ambulatory Medical Care Survey. According to the study, they analyzed visits from 2000 to 2015 with ICD-9-CM diagnosis codes for purulent SSTIs.

“From 2000 to 2013, there was a dramatic rise in the incidence of ambulatory visits for purulent SSTI, followed by a plateau,” Fritz said. “When we looked specifically at children (up to age 17 years), again we witnessed a dramatic increase in the visit rate (per 1,000 population) between 2000 and 2010, followed by a statistically significant decrease from 2011 to 2015.”

According to the study, the total annual number of visits for purulent SSTI-related visits to ambulatory physicians in the U.S. increased from 5.4 million in 2000 to a peak of 11.35 million in 2013, and then declined to 8.4 million in 2015. Additionally, the annual visit rate per 1,000 population for purulent SSTI increased from 19.5 visits in 2000 to 34.2 visits in 2010, and after 2010, visits per 1,000 population were more stable, measuring 34.6 in 2011 and 26.6 in 2015.

Following a significant increase in SSTIs in children from 2000 to 2010, the annual visit rate per 1,000 population significantly decreased from 25.7 in 2011 to 12.8 in 2015, Fritz and colleagues reported.

Fritz added that overall, 69% of patients received antibiotics for purulent SSTI, and this proportion did not change significantly over the study period.

“While the incidence of SSTI in the U.S. has plateaued overall and has declined in children, the overall health care burden of SSTIs remains substantial,” Fritz concluded. “Thus, we need to pursue an understanding of the most effective treatments and prevention strategies for these infections.”– by Caitlyn Stulpin

Disclosure: Fritz reports no relevant financial disclosures.