The Incidence of Skin and Soft Tissue Infections in the United States and Associated Healthcare Utilization Between 2010 and 2020

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Abstract

Background

The number of patients with skin and soft tissue infections (SSTIs) in the United States appeared to be increasing well into the 21st century. However, no recent data have confirmed this trend.

Methods

This retrospective, observational cohort study used claims data over 11 years (2010–2020) from Optum's de-identified Clinformatics Data Mart Database. SSTI episodes, complications, and comorbidities were identified using International Classification of Diseases codes. Annual SSTI incidence rates, proportions of recurrent SSTI, SSTI-associated deaths, and total costs were estimated.

Results

During the study period, 5.4 million patients experienced 9.1 million SSTI episodes, with an incidence of 77.5 (95% confidence interval, 77.4–77.5) per 1000 person-years of observation (PYO). Annual incidence did not change significantly over time. Overall incidence (per 1000 PYO) of SSTI episodes in patients without comorbidities was 32.1 (highest incidence was for previous SSTI [113.5]) versus much higher rates if comorbidities were present. Incidence rates (per 1000 PYO) of chronic ulcers increased over time from 11.3 to 18.2 ( P < .0001) and complicated disease from 3.5 to 6.3 ( P < .0001). Deaths occurring within 30 days post–SSTI hospitalization rose from 2.6% to 4.6% in 2020. Recurrences occurred in 26.3% of index cases. The mean cost of an SSTI episode was US$3334 (median US$190) and was highest for surgical site infections and chronic ulcers.

Conclusions

The epidemiology of SSTI in the United States is changing and the disease burden is increasing despite stabilization in overall incidence. These data can inform identification of priority populations who could benefit from targeted interventions.

Abstract

Skin and soft tissue infections in the United States are evolving, with increasing rates of chronic ulcers that frequently develop complications and cause hospitalizations, of which 1% end in death. These data can guide identification of target populations who could benefit most from preventive interventions.

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Most cited references 19

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National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections.

Adam Hersh, Henry Chambers, Judith Maselli … (2008)

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a common cause of skin and soft-tissue infections (SSTIs) in the United States. It is unknown whether this development has affected the national rate of visits to primary care practices and emergency departments (EDs) and whether changes in antibiotic prescribing have occurred. We examined visits by patients with SSTIs to physician offices, hospital outpatient departments, and EDs using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1997 to 2005. We estimated annual visit rates for all SSTIs and a subset classified as abscess/cellulitis. For abscess/cellulitis visits, we examined trends in characteristics of patients and clinical settings and in antibiotic prescribing. Overall rate of visits for SSTIs increased from 32.1 to 48.1 visits per 1000 population (50%; P = .003 for trend), reaching 14.2 million by 2005. More than 95% of this change was attributable to visits for abscess/cellulitis, which increased from 17.3 to 32.5 visits per 1000 population (88% increase; P < .001 for trend). The largest relative increases occurred in EDs (especially in high safety-net-status EDs and in the South), among black patients, and among patients younger than 18 years. Use of antibiotics recommended for CA-MRSA increased from 7% to 28% of visits (P < .001) during the study period. Independent predictors of treatment with these antibiotics included being younger than 45 years, living in the South, and an ED setting. The incidence of SSTIs has rapidly increased nationwide in the CA-MRSA era and appears to disproportionately affect certain populations. Although physicians are beginning to modify antibiotic prescribing practices, opportunities for improvement exist, targeting physicians caring for patients who are at high risk.

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Trends in US Hospital Admissions for Skin and Soft Tissue Infections

John Edelsberg, Charu Taneja, Marcus J Zervos … (2009)

Using data from the 2000–2004 US Healthcare Cost and Utilization Project National Inpatient Sample, we found that total hospital admissions for skin and soft tissue infections increased by 29% during 2000–2004; admissions for pneumonia were largely unchanged. These results are consistent with recent reported increases in community-associated methicillin-resistant Staphylococcus aureus infections.

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Increased US emergency department visits for skin and soft tissue infections, and changes in antibiotic choices, during the emergence of community-associated methicillin-resistant Staphylococcus aureus.

Daniel J Pallin, Daniel J Egan, Andrea J Pelletier … (2008)

Test the hypotheses that emergency department (ED) visits for skin and soft tissue infections became more frequent during the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA), and that antibiotics typically active against community-associated MRSA were chosen increasingly. From merged National Hospital Ambulatory Medical Care Survey data for 1993-2005, we identified ED visits with diagnosis of cellulitis, abscess, felon, impetigo, hidradenitis, folliculitis, infective mastitis, nonpurulent mastitis, breast abscess, or carbuncle and furuncle. Main outcomes were change over time in rate of ED visits with such a diagnosis and proportion of antibiotic regimens including an agent typically active against community-associated MRSA. We report national estimates derived from sample weights. We tested trends with least squares linear regression. In 1993, infections of interest were diagnosed at 1.2 million visits (95% confidence interval [CI] 0.96 to 1.5 million) versus 3.4 million in 2005 (95% CI 2.8 to 4.1 million; P for trend <.001). As a proportion of all ED visits, such infections were diagnosed at 1.35% in 1993 (95% CI 1.07% to 1.64%) versus 2.98% in 2005 (95% CI 2.40% to 3.56%; P for trend <.001). When antibiotics were prescribed at such visits, an antibiotic typically active against community-associated MRSA was chosen rarely from 1993 to 2001 but increasingly thereafter, reaching 38% in 2005 (95% CI 30% to 45%; P for trend <.001). In 2005, trimethoprim-sulfamethoxazole was used in 51% of regimens active against community-associated MRSA. US ED visits for skin and soft tissue infections increased markedly from 1993 to 2005, contemporaneously with the emergence of community-associated MRSA. ED clinicians prescribed more antibiotics typically active against community-associated MRSA, especially trimethoprim-sulfamethoxazole. Possible confounders are discussed, such as increasing diabetes or shifts in locus of care.

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Author and article information

Contributors

Venanzio Vella:

ORCID: https://orcid.org/0000-0002-3213-6258

Dominique Derreumaux

Emmanuel Aris:

ORCID: https://orcid.org/0000-0001-8640-1742

Michele Pellegrini:

ORCID: https://orcid.org/0000-0001-8505-9260

Mario Contorni

Michael Scherbakov:

ORCID: https://orcid.org/0000-0002-9189-4729

Fabio Bagnoli

Journal

Journal ID (nlm-ta): Open Forum Infect Dis

Journal ID (iso-abbrev): Open Forum Infect Dis

Journal ID (publisher-id): ofid

Title: Open Forum Infectious Diseases

Publisher: Oxford University Press (US )

ISSN (Electronic): 2328-8957

Publication date Collection: June 2024

Publication date (Electronic): 07 May 2024

Publication date PMC-release: 07 May 2024

Volume: 11

Issue: 6

Electronic Location Identifier: ofae267

Affiliations

Vaccine Epidemiology–Bacterial, GSK , Siena, Italy

Real World Analytics, GSK , Wavre, Belgium

Vaccines Clinical Sciences, GSK , Siena, Italy

Early Bacterial Vaccine Program, GSK , Siena, Italy

Global Medical Affairs, GSK , Wavre, Belgium

Infectious Diseases Research Unit, GSK , Siena, Italy

Author notes

Correspondence: Venanzio Vella, MD, PhD, Vaccine Epidemiology–Bacterial, GSK, Via Fiorentina 1, 53100 Siena, Italy ( venanzio.x.vella@ 123456gsk.com ).

Potential conflicts of interest. E. A., M. P., F. B., V. V., and M. S. are employed by and hold financial equities in GSK. D. D. is employed by GSK. M. C. was employed by GSK at the time of the study. These authors declare no other financial and non-financial relationships and activities.

Author information

Venanzio Vella https://orcid.org/0000-0002-3213-6258

Emmanuel Aris https://orcid.org/0000-0001-8640-1742

Michele Pellegrini https://orcid.org/0000-0001-8505-9260

Michael Scherbakov https://orcid.org/0000-0002-9189-4729

Article

Publisher ID: ofae267

DOI: 10.1093/ofid/ofae267

PMC ID: 11146672

PubMed ID: 38835497

SO-VID: 1441b233-f64d-48b2-8d13-86d3f8cf5430

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 14 March 2024

Date: 01 May 2024

Date accepted : 06 May 2024

Date: 03 June 2024

Page count

Pages: 9

Funding

Funded by: GlaxoSmithKline Biologicals SA, DOI 10.13039/100020955;

Award ID: VEO-000423;

Award ID: B15390

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The Incidence of Skin and Soft Tissue Infections in the United States and Associated Healthcare Utilization Between 2010 and 2020

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Most cited references 19

National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections.

Trends in US Hospital Admissions for Skin and Soft Tissue Infections

Increased US emergency department visits for skin and soft tissue infections, and changes in antibiotic choices, during the emergence of community-associated methicillin-resistant Staphylococcus aureus.

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