633 - Identifying Risk Factors Changing for Single V. Recurrent Community Associated Staphylococcus aureus Skin and Soft Tissue Infections among Children in Georgia (2002-2019)

Publication Number: 633.5536

Shifan Yan, Emory University Rollins School of Public Health, Atlanta, GA, United States; Lilly Immergluck, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine, Chicago, IL, United States; Traci Leong, Emory University School of public health, Atlanta, GA, United States; Declan Quinn, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine, Elmhurst, IL, United States; Samuel Owusu, Morehouse School of Medicine, Atlanta, GA, United States; Daria Anderson, Morehouse School of Medicine, owings mills, MD, United States; Xiting Lin, Morehouse School of Medicine, Atlanta, GA, United States; Peter Baltrus, Morehouse School of Medicine, Atlanta, GA, United States

Background: Staphylococcus aureus (SA) is a commensal and pathogenic bacterium, which colonizes 25-40% of humans and community acquired antibiotic resistant SA, including methicillin resistance SA (MRSA) has contributed to single and recurrent skin and soft tissue infections (SSTI). Community acquired (CA) MRSA reached epidemic levels in the early 2000s, disproportionately affecting African Americans and children.Despite the prevelance of recurrent infections, little is known about the risk factors for recurrence.

Objective: The primary objective is to identify individual and area-level risk factors temporally and spatially associated with SSTI, and to examine risk differences contributing to recurrent SSTI.

Design/Methods: This is a retrospective study of children ( < 19 years) in Atlanta with SSTI, using electronic health records from 2 pediatric hospitals (2002-2019). Patients had a single- or recurrent- SSTI caused by either methicillin sensitive (MSSA) or MRSA. Sociodemographic data was collected on race, ethnicity, age, sex, and health insurance. Most patients’ residences were geocoded to the respective census tract. U.S. Census data for area-level variables were collected on proxies for poverty, education, unemployment, and household crowding. Spatial analyses included hot and cold spots for recurrent versus single episode SSTI, and then stratified by methicillin susceptibility using ArcGIS Pro.

Results: 20,361 children were included in the study (18,608 single-episode and 1,753 recurrent SSTI.) Statistical significance was found between rates of single- and recurrent- SSTI in the white and black population. Single-episode data was similar (45.4% of the infections were in white patients while 41.5% were in black patients), but there was difference between recurrent rates. Of the recurrent infections, white patients made up 65.4% and black patients made up 25.0% of infections. The type of health insurance the patient had also showed statistical significance. Patients with public insurance made up 77.6 % and 70.8% of recurrent- and single- SSTI, respectively. Spatial analysis revealed hotspots for recurrent SSTI in Atlanta, exhibiting distinct patterns between single episodes and recurrent SSTI.

Conclusion(s): The study shows persistant disparities among single episode SSTI, which did not translate to reccurent SSTI. Sociodemographic differences displayed statistical significance as patients with public insurance were more likely to develop single- and recurrent- SSTI. Hotspots for single- and recurrent- SSTI were significantly different in the Atlanta area.

Demographic Breakdown by Type of Skin and Soft Tissue Infection
The total number of skin and soft tissue infections broken down in the demographic subcategories (such as race and type of health insurance.)