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

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.