More Children Hospitalized With Skin Infections

Severe skin infections that resist antibiotics have become one of the most common reasons children are hospitalized, new data show.

A new report from the Agency for Healthcare Research and Quality shows that in the past decade, there have been a number of shifts in the reasons children are admitted to the hospital. The most notable change in hospital admission data involves severe skin infections, which more than doubled between 2000 and 2009 and now rank as the 7th most common reason for childhood hospitalization, up from 13th in 2000.

The increase is attributed to the rise of antibiotic-resistant staph infections — called methicillin-resistant Staphylococcus aureus, or MRSA. The vast majority of MRSA cases happen in hospital settings or nursing homes, but 10 percent to 15 percent occur in the community among otherwise healthy people. Infections often strike people who are prone to cuts and scrapes, including children and athletes. MRSA spreads by skin-to-skin contact, typically in crowded conditions and through the sharing of contaminated personal items like towels.

“I don’t think it’s really well appreciated that in most communities, community-acquired MRSA has become the dominant cause of soft tissue infection requiring emergency department care and in-patient care,” said Dr. Patrick S. Romano, professor of medicine and pediatrics at the University of California-Davis School of Medicine. “People think of MRSA as a hospital bug, but it’s not just a hospital bug any more. It’s a community bug.”

In 2009, the rate of skin infections among children that required hospitalization climbed to 9.4 cases per 10,000 children, up from about 4.5 cases per 10,000 in the year 2000. Overall, about 71,900 children spent time in the hospital in 2009 because of severe skin infections.

There have been a number of anecdotal reports of children infected with MRSA, including some deaths, and in recent years several schools have closed to allow cleaning crews to disinfect buses, athletic locker rooms and classrooms. In 2007, a report from the Centers for Disease Control and Prevention found that nearly 19,000 people had died in the United States in 2005 from an invasive form of MRSA infection, suggesting that community-based cases of MRSA may be twice as common as previously thought.

Infections caused by MRSA often resemble a pimple, boil or spider bite but quickly worsen into an abscess or pus-filled blister or sore. Patients who have sores that won’t heal or are filled with pus should see a doctor and ask to be tested for staph infection.

“If your child develops a painful boil, especially on the buttocks, don’t wait for it to go away by itself or try to drain it at home,” said Dr. Romano. “Go see your child’s doctor.”

Most of the time, treatment can be handled at the doctor’s office or a clinic, and the child will be given oral antibiotics. Sometimes doctors may recommend warm compresses rather than medication, but if the infection doesn’t clear up within a day or two, the patient should see a doctor again, said Dr. Romano,, a co-author on a June report in the journal Academic Pediatrics that also analyzed childhood hospitalization data.

In addition to a rise in skin infections, the hospitalization data show that far more children are being admitted to the hospital for flu. However, doctors say this change likely represents better diagnostic techniques, including rapid flu tests, so that hospitalizations that in the past were attributed to general respiratory illness are now being categorized as flu. As a result, flu is now the 10th most common reason children are hospitalized, up from 65th in 2000.

Other notable changes in the hospitalization report include a decline in the rate of hospital admissions for teenage pregnancy, which dropped to 22 per 10,000 children in 2009, down nearly 25 percent from a high of 28.7 per 10,000 in 2000. Hospitalizations due to injuries and poisonings dropped to 7.1 per 10,000 children, down from 8.7 per 10,000 in 2000.