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Despite increase in MRSA, no change in rate of office visits for dermatitis, SSTI
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The emergence of community-acquired methicillin-resistant Staphylococcus aureus in recent years was not accompanied by an increase in office visits for dermatitis and/or skin and soft-tissue infection, according to results of a recent study.
The study results indicated that the rate of office visits for dermatitis or skin and soft-tissue infection (SSTI) did not increase from 1993 through 2005.
The study was designed to determine whether office visits for dermatitis or SSTI became more frequent after the emergence of CA-MRSA, as some researchers had expected.
The researchers analyzed visits for the diagnoses of dermatitis and SSTI by means of codes from the International Classification of Diseases, Ninth Revision recorded in the National Ambulatory Medical Care Survey, 1993–2005. Population estimates were calculated by year and age group; trends over time were studied.
Results indicated that there was an average of 13 million diagnoses of dermatitis at office visits per year during the study period. There was an average of 6.3 million diagnoses of SSTI at office visits per year during the study period. The frequency of diagnosis did not change for either dermatitis or SSTI over time when expressed as a percentage of all office visits.
The results also indicated that dermatitis was most common among infants (an average 256 visits per 1,000 population per year) but that the rate of diagnosis of SSTI did not vary significantly by age. The risk of dermatitis was associated with SSTI, although this association did not strengthen over time.
The findings were somewhat surprising to some researchers, who expected to see an increase in office visits for dermatitis and SSTI that would coordinate to the increasing emergence of CA-MRSA. The researchers cited an earlier study’s findings that indicated emergency department visits for dermatitis and SSTI increased after 1997.
“There are two likely explanations for this discrepancy [between these two studies],” the researchers of the new study wrote. “First, there was a drop in the rate from 1996 to 1997, and thus the selection of 1997 as the start year, rather than 1996 or an earlier year, biased the prior study toward finding an increase. To compare our study with the prior one, we analyzed visits from 1997 through 2005 and did find an apparent increase in the population rate.”
The researchers said the second discrepancy may have come about because the earlier study examined both emergency department and office visits. “We know from another study that there was a large increase in the frequency of SSTI visits to the emergency department,” the researchers wrote. “Combining data from the emergency department and office settings led to a finding of an increase overall, because the increase in the emergency department setting was large enough to outweigh the stability in the much larger office setting.”
The researchers said that this is important because it indicates where most SSTI patients are being examined. “We are indeed in the midst of an epidemic of SSTI, but the health care impact of the epidemic appears to be limited to the emergency department setting.”
Pallin D. Clin Infect Dis. 2009;49:901-907.