Epidemiology of Dermatitis and Skin Infections in United States Physicians' Offices, 1993-2005
Epidemiology of Dermatitis and Skin Infections in United States Physicians' Offices, 1993-2005
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DOI：
10.1086/605434
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发表时间：
2009-09-15
影响因子：
11.8
通讯作者：
Camargo, Carlos A., Jr.
中科院分区：
文献类型：
--
作者：
Pallin, Daniel J.;Espinola, Janice A.;Camargo, Carlos A., Jr.
背景。自从发现社区相关的耐甲氧西林金黄色葡萄球菌（MRSA）以来，因皮肤和软组织感染（SSTI）就诊的急诊人数有所增加，一份报告显示，在更大的医生办公室环境中，就诊人数有所增加。皮炎损害皮肤对微生物的屏障，可能易患SSTI。我们的目的是确定自从社区相关MRSA出现以来，皮炎或SSTI就诊是否变得更加频繁，描述皮炎和SSTI就诊的年龄特异性频率，并确定皮炎是否与SSTI相关，以及这种关联是否随着时间的推移而增强。我们通过1993-2005年国家门诊医疗调查中记录的《国际疾病分类第九版》中的代码，分析了皮炎和SSTI诊断的就诊情况。我们按年份和年龄组计算人口估计数，95%置信区间（ci），并检查了随时间的趋势。多变量logistic回归量化了皮炎与SSTI之间的相关性，并评估了皮炎与年份在预测SSTI中的相互作用。在研究期间，每年有1300万次就诊被诊断为皮炎（95% CI，每年1200万至1400万次就诊），每年有630万次就诊被诊断为SSTI （95% CI，每年580万至680万次就诊）。当以占所有就诊的百分比表示时，两种诊断的频率都没有随着时间的推移而改变（P均为0.60）。皮炎在婴儿中最为常见（每年每1000人就诊256次；95%置信区间为每年每1000人就诊216-293次）。SSTI诊断率随年龄变化不明显。皮炎与SSTI相关（优势比2.54;95% CI 1.92-3.35）。这种关联并没有随着时间的推移而增强。从1993年到2005年，皮炎或性传播感染的就诊率没有增加。皮炎与SSTI相关。随着社区相关MRSA的流行，这种联系并没有加强。
Background. Since the discovery of community-associated methicillin-resistant Staphylococcus aureus (MRSA), the number of emergency department visits for skin and soft-tissue infection (SSTI) has increased, and one report suggested an increase in the much larger setting of physicians' offices. Dermatitis compromises the cutaneous barrier to microorganisms and may predispose to SSTI. Our objectives were to determine whether office visits for dermatitis or SSTI have become more frequent since the emergence of community-associated MRSA, to describe the age-specific frequency of visits for dermatitis and SSTI, and to determine whether dermatitis is associated with SSTI and whether the association strengthened over time.Methods. We 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. We calculated population estimates by year and age group, with 95% confidence intervals (CIs), and examined trends over time. Multivariate logistic regression quantified the association between dermatitis and SSTI and assessed for interaction between dermatitis and year in the prediction of SSTI.Results. Dermatitis was diagnosed at 13 million office visits per year (95% CI, 12-14 million office visits per year) over the study period, and SSTI was diagnosed at 6.3 million office visits per year (95% CI, 5.8 million-6.8 million office visits per year). The frequency did not change for either diagnosis over time when expressed as a percentage of all visits (both, P> .60). Dermatitis was most common among infants (256 visits per 1,000 population per year; 95% CI, 216-293 visits per 1,000 population per year). The rate of diagnosis of SSTI did not vary importantly by age. Dermatitis was associated with SSTI (odds ratio, 2.54; 95% CI, 1.92-3.35). The association did not strengthen over time.Conclusions. The rate of office visits for dermatitis or SSTI did not increase from 1993 through 2005. Dermatitis was associated with SSTI. This association did not strengthen as community-associated MRSA became prevalent.