Hospital admissions for skin and soft tissue infections in a population with endemic scabies: A prospective study in Fiji, 2018-2019.
Hospital admissions for skin and soft tissue infections in a population with endemic scabies: A prospective study in Fiji, 2018-2019.
复制标题
DOI：
10.1371/journal.pntd.0008887
复制
发表时间：
2020-12
影响因子：
3.8
通讯作者：
Steer AC
中科院分区：
文献类型：
--
作者：
Thean LJ;Jenney A;Engelman D;Romani L;Wand H;Mudaliar J;Paka J;Cua T;Taole S;Sahukhan A;Kama M;Tuicakau M;Kado J;Carvalho N;Whitfeld M;Kaldor J;Steer AC
疥疮是脓疱疹的一个重要诱发因素，但其在更严重的皮肤和软组织感染（SSTI）中的作用尚不清楚。关于在地方性疥疮存在的情况下SSTI发病率的信息有限。我们对斐济北方省（人口：131，914）的SSTI住院情况进行了一项前瞻性研究。2018年至2019年期间，在该部门的转诊医院对因脓疱病、脓肿、蜂窝织炎、伤口感染、化脓性肌炎、坏死性筋膜炎、感染性疥疮和结痂性疥疮住院的患者进行了前瞻性监测。收集有关人口统计学特征、临床特征、微生物学、治疗和结局的信息。在研究期间，记录了788例SSTI入院，相当于人口发病率为每100，000人年647例（95%CI 571-660）。年龄极端的发病率最高，5岁以下儿童（908/100，000）和≥65岁儿童（1127/100，000）的发病率最高。土著斐济人的发病率（每100 000人中有753人）是其他族裔（每100 000人中有442人）的1.7倍。总病死率为3.3%，年龄≥65岁者为10.8%。在所有患者中有7.6%同时诊断出疥疮，在5岁以下的住院儿童中有24.6%同时诊断出疥疮。在斐济，与高收入环境相比，特别是在最年轻、最年长和土著人口中，因SSTI住院的负担非常高，这与疥疮和脓疱病在这一人口中的分布一致。我们的研究结果强调，需要制定战略，以减轻负担的SSTI在斐济和类似的设置。疥疮与地方性人群中的脓疱病有因果关系。反过来，脓疱病可以进展为更严重的皮肤和软组织感染（SSTI）。然而，在疥疮流行的环境中，关于SSTI的流行病学数据很少。我们对2018年和2019年斐济北方省（人口131，914）转诊中心的SSTI住院率进行了前瞻性研究，该地区社区疥疮患病率非常高。我们测量了因脓肿、蜂窝织炎、脓疱病、伤口感染、化脓性肌炎、坏死性筋膜炎和结痂性疥疮而入院的发病率。我们观察到SSTI的高发病率（647例/100，000人年），在这一人群中具有较高的相关发病率和病死率。我们发现，幼儿、老年人和土著斐济人的发病率非常高，这与社区疥疮和脓疱病的分布情况相一致。这些发现强调了SSTI是一个重要的公共卫生问题，并进一步推动了对减轻这一负担的战略的研究。
Scabies is an important predisposing factor for impetigo but its role in more serious skin and soft tissue infections (SSTIs) is not well understood. Information is limited on incidence of SSTIs in the presence of endemic scabies. We conducted a prospective study of hospital admissions for SSTIs in the Northern Division of Fiji (population: 131,914). Prospective surveillance for admissions with impetigo, abscess, cellulitis, wound infection, pyomyositis, necrotizing fasciitis, infected scabies, and crusted scabies was conducted at the Division’s referral hospital between 2018 to 2019. Information was collected on demographic characteristics, clinical features, microbiology, treatment and outcomes. Over the study period, 788 SSTI admissions were recorded corresponding to a population incidence 647 per 100,000 person-years (95%CI 571–660). Incidence was highest at the extremes of age with peak incidence in children aged <5 years (908 per 100,000) and those aged ≥65 years (1127 per 100,000). Incidence was 1.7 times higher among the Indigenous Fijian population (753 per 100,000) compared to other ethnicities (442 per 100,000). Overall case fatality rate was 3.3%, and 10.8% for those aged ≥65 years. Scabies was diagnosed concurrently in 7.6% of all patients and in 24.6% of admitted children <5 years. There is a very high burden of hospital admissions for SSTIs in Fiji compared to high-income settings especially among the youngest, oldest and indigenous population which is concordant with scabies and impetigo distribution in this population. Our findings highlight the need for strategies to reduce the burden of SSTIs in Fiji and similar settings. Scabies is causally linked to impetigo in endemic populations. In turn, impetigo can progress to more serious skin and soft tissue infections (SSTI). However, there are few data on the epidemiology of SSTIs in settings where scabies is endemic. We conducted a prospective study of the incidence of hospitalizations for SSTIs in 2018 and 2019 at the referral centre for the Northern Division of Fiji (population of 131,914) where community scabies prevalence is very high. We measured the incidence of admissions for abscesses, cellulitis, impetigo, wound infections, pyomyositis, necrotizing fasciitis and crusted scabies. We observed a high incidence of SSTI admissions (647 cases per 100,000 person-years) with high associated morbidity and case fatality in this population. We found a very high incidence in young children, the elderly and iTaukei (Indigenous Fijian) population which is concordant with the distribution of scabies and impetigo in the community. These findings highlight SSTIs as an important public health concern and provide further impetus to advance research into strategies that will alleviate this burden.
登录
查看更多内容
影响因子：
0.6
作者：
Guerrier, Gilles;de Montera, Anne-Marie;Steer, Andrew
通讯作者：
Steer, Andrew
影响因子：
--
作者：
Linder, Kristin E;Nicolau, David P;Nailor, Michael D
通讯作者：
Nailor, Michael D
影响因子：
3.7
作者：
Li X;Chen Y;Gao W;Ouyang W;Wei J;Wen Z
通讯作者：
Wen Z
影响因子：
3.7
作者：
Bowen AC;Mahé A;Hay RJ;Andrews RM;Steer AC;Tong SY;Carapetis JR
通讯作者：
Carapetis JR
影响因子：
3.6
作者：
Steer, Andrew C.;Jenney, Adam W. J.;Carapetis, Jonathan R.
通讯作者：
Carapetis, Jonathan R.