Increasing Incidence of Staphylococcal Scalded Skin Syndrome in the United States

Staphylococcal scalded skin syndrome (SSSS), which is on the rise among adults in the United States, is associated with substantial patient morbidity and costs, but not with increased inpatient mortality, according to the results of an analysis of the 2008 to 2012 Nationwide Inpatient Sample, which included a 20% sample of US hospitalizations. Findings from the analysis were published in the Journal of the American Academy of Dermatology.¹

The investigators sought to describe the incidence, comorbidities, associations, mortality, and financial burden of SSSS in American adults. In the current analysis, the annual incidence of SSSS was 0.98 (minimum to maximum: 0.94 to 1.02) per million US adults.¹ This figure is actually lower than previously reported among children in the same time period.²

The incidence of SSSS increased with age (18- to 39-year-old age group: 0.30 per million; 40- to 59-year-old age group: 0.93 per million; 60- to 79-year-old age group: 2.01 per million; and ≥80-year-old age group: 3.91 per million). These findings were similar to those reported among children with SSSS.²

The use of multivariable survey-weighted logistic regression models showed that SSSS was linked with increasing age (adjusted odds ratio [aOR] for 40- to 59-year-old age group, 2.01; 95% CI, 1.56-2.60; aOR for 60- to 79-year-old age group, 1.54; 95% CI, 1.17-2.02, compared with the 18- to 39-year-old age group).

Moreover, SSSS was also associated with black race/ethnicity (aOR, 1.26; 95% CI, 1.02-1.55), lowest-quartile household income (aOR, 1.31; 95% CI, 1.04-1.66), being uninsured (aOR, 1.81; 95% CI, 1.42-2.32), having more chronic conditions (aOR for 2-5 chronic conditions, 1.48; 95% CI, 1.13-1.95 and aOR for 6+ chronic conditions, aOR, 1.77; 95% CI, 1.33-2.36), hospital location in a nonmetropolitan/micropolitan county (aOR, 1.40; 95% CI, 1.06-1.85) and Midwestern US (aOR, 1.39; 95% CI, 1.10-1.75), and with medium hospital size (aOR, 1.31; 95% CI, 1.04-1.64) and large hospital size (aOR, 0.70; 95% CI, 0.56-0.87)

In contrast, SSSS was inversely associated with being hospitalized in a teaching hospital (aOR, 0.62; 95% CI, 0.53-0.73).

The most common comorbidities reported among patients with SSSS included skin infections, renal failure, diabetes, sepsis, substance abuse, cancer, pneumonia, and fungal infections.

The investigators concluded that SSSS is increasing in incidence among US adults and is associated with significant comorbidities and a financial burden.

References

1. Staiman A, Hsu DY, Silverberg JI. Epidemiology of staphylococcal scalded skin syndrome in United States adults [published online June 11, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.06.008

2. Staiman A, Hsu DY, Silverberg JI. Epidemiology of staphylococcal scalded skin syndrome in U.S. children. Br J Dermatol. 2018;178(3):704-708.