Epidemiology of staphylococcal scalded skin syndrome in U.S. children

Abstract

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.