Abstract
BackgroundSkin and soft tissue infections (SSTIs) are commonly occurring infections with wide-ranging clinical manifestations, from mild to life-threatening. There are few population-based studies of SSTIs in the period after the rapid increase in community-acquired methicillin-resistant Staphyloccus aureus (MRSA).MethodsWe used electronic databases to describe the incidence, microbiology, and patient characteristics of clinically-diagnosed skin and soft tissue infections (SSTIs) among members of a Northern California integrated health plan. We identified demographic risk factors associated with SSTIs and MRSA infection.ResultsDuring the three-year study period from 2009 to 2011, 376,262 individuals experienced 471,550 SSTI episodes, of which 23% were cultured. Among cultured episodes, 54% were pathogen-positive. Staphylococcus aureus (S. aureus) was isolated in 81% of pathogen-positive specimens, of which nearly half (46%) were MRSA. The rate of clinically-diagnosed SSTIs in this population was 496 per 10,000 person-years. After adjusting for age group, gender, race/ethnicity and diabetes, Asians and Hispanics were at reduced risk of SSTIs compared to whites, while diabetics were at substantially higher risk compared to non-diabetics. There were strong age group by race/ethnicity interactions, with African Americans aged 18 to <50 years being disproportionately at risk for SSTIs compared to persons in that age group belonging to other race/ethnicity groups. Compared to Whites, S. aureus isolates of African-Americans and Hispanics were more likely to be MRSA (Odds Ratio (OR): 1.79, Confidence Interval (CI): 1.67 to 1.92, and, OR: 1.24, CI: 1.18 to 1.31, respectively), while isolates from Asians were less likely to be MRSA (OR: 0.73, CI: 0.68 to 0.78).ConclusionsSSTIs represent a significant burden to the health care system. The majority of culture-positive SSTIs were caused by S. aureus, and almost half of the S. aureus SSTIs were methicillin-resistant. The reasons for African-Americans having a higher likelihood, and Asians a lower likelihood, for their S. aureus isolates to be methicillin-resistant, should be further investigated.
Highlights
Skin and soft tissue infections (SSTIs) are commonly occurring infections with wide-ranging clinical manifestations, from mild to life-threatening
The rate of clinically-diagnosed SSTIs was 496 per 10,000 person-years, with the highest crude incidence rates being in persons 65 years of age and older, Native Americans, African-Americans, persons identified as Multiracial, and persons with diabetes (Table 2)
After adjusting for patient demographics and diabetes, children under 5 years of age had higher rates of SSTI than persons aged 65 years and older (Rate Ratio (RR): 1.21, Confidence Interval (CI): 1.17 to 1.26), while persons in other age groups had lower rates of SSTIs compared to persons aged 65 years and older
Summary
Skin and soft tissue infections (SSTIs) are commonly occurring infections with wide-ranging clinical manifestations, from mild to life-threatening. Skin and soft tissue infections (SSTIs) are common clinical conditions ranging from mild to life-threatening [1,2]. Among culture-confirmed SSTIs in the United States, the most common cause is S. aureus, Pseudomonas aeruginosa, Enterococcus spp., Escherichia coli, and BHS have been identified as important causes of some types of SSTIs [1,7,8,9,10,11]. Studies reported increasing numbers of emergency department visits and hospitalizations for SSTIs [23,24,25], contemporaneous with the emergence of CA-MRSA. There are some indications that the rate of MRSA infections has stabilized or declined in the last few years [27,28,29,30]
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