Epidemiology of Staphylococcal Scalded Skin Syndrome in United States Children

Abstract

Background

Staphylococcal scalded skin syndrome (SSSS) is a blistering dermatosis caused by exfoliative toxins released from Staphylococcus aureus. We sought to describe the incidence, costs, length of stay (LOS), comorbidities, and mortality of SSSS in US children.

Methods

The Nationwide Inpatient Sample 2008-2012 was analyzed, including a 20% sample of US hospitalizations and 589 cases of SSSS.

Results

The annual incidence of SSSS was 7.67 (range: 1.83–11.88) per-million US children, with 45.1 cases per-million US infants age <2 years. In multivariate logistic regression models, SSSS was significantly associated with female sex (adjusted odds ratio [95% confidence interval]:1.12 [1.00–1.25]), age (2-5yr:13.31 [11.82-14.99], 6-10yr:2.93 [2.35–3.66], 11-17yr:0.44 [0.31–0.63]), race/ethnicity (blacks:0.69 [0.58–0.84]), season (winter:2.04 [1.66–2.50], summer:3.47 [2.86–4.22], fall: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% CI) LOS and cost of hospitalization for patients with vs. without SSSS was 3.2 (3.0-3.4) vs. 2.4 (2.4-2.5) days and $4,624.0 [$4,250.8-$5,030.1] vs. $1,871.7 [$1,782.7-$1,965.1]. Crude inpatient mortality rates 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 upper respiratory tract and skin.

Conclusions

SSSS prevalence appears to be increasing over time, and was associated with a number of socio-demographic factors and other infections. Further studies are needed to confirm these findings and reduce rising rates of SSSS.

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