Increasing national burden of hospitalizations for skin and soft tissue infections in children

Background: The number of children requiring treatment of skin and soft tissue infections (SSTIs) has increased since the emergence of methicillin-resistant Staphylococcus aureus. Methods: The 2000, 2003, and 2006 Kids' Inpatient Databases were queried for patients with a primary diagnosis of SSTI. Weighted data were analyzed to estimate temporal changes in incidence, incision and drainage (I&D) rate, and economic burden. Factors associated with I&D were analyzed by multivariable logistic regression. Results: Pediatric SSTI admissions increased (1) in number, (2) as a fraction of all hospital admissions, and (3) in incidence per 100,000 children from the years 2000 (17,525 ± 838; 0.65%; 23.2) to 2003 (27,463 ± 1652; 0.99%; 36.2) and 2006 (48,228 ± 2223; 1.77%; 62.7). Children younger than 3 years accounted for 49.6% of SSTI admissions in 2006, up from 32.5% in 2000. Utilization of I&D increased during the study period from 26.0% to 43.8%. Factors most associated with requiring I&D were age less than 3 years and calendar year 2006 (both P <.001). Hospital costs per patient increased over time and were higher in the group of patients who required I&D ($4296 ± $84 vs $3521 ± $81; P <.001; year 2006). Aggregate national costs reached $184.0 ± $9.4 million in 2006. Conclusion: The recent spike in pediatric SSTIs has disproportionately affected children younger than 3 years, and an increasing fraction of these children require I&D. The national economic burden is substantial.