Impetigo: Incidence and treatment in Dutch general practice in 1987 and 2001—Results from two national surveys

Department of Paediatrics, Erasmus MC, University Medical Centre Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
British Journal of Dermatology (Impact Factor: 4.28). 02/2006; 154(2):239-43. DOI: 10.1111/j.1365-2133.2005.06766.x
Source: PubMed


Impetigo is a common skin infection in children. The epidemiology is relatively unknown, and the choice of treatment is subject to debate.
The objective of our study was to determine the incidence and treatment of impetigo in Dutch general practice, and to assess trends between 1987 and 2001.
We used data from the first (1987) and second (2001) Dutch national surveys of general practice. All diagnoses, prescriptions and referrals were registered by the participating general practitioners (GPs), 161 and 195, respectively.
The incidence rate of impetigo increased from 16.5 (1987) to 20.6 (2001) per 1000 person years under 18 years old (P < 0.01). In both years, the incidence was significantly higher in summer, in rural areas and in the southern region of the Netherlands, compared with winter, urban areas and northern region, respectively. Socioeconomic status was not associated with the incidence rate. From 1987 to 2001, there was a trend towards treatment with a topical antibiotic (from 43% to 64%), especially fusidic acid cream and mupirocin cream. Treatment with oral antibiotics (from 31% to 14%) and antiseptics (from 11% to 3%) was prescribed less often.
We have shown an increased incidence of impetigo in the past decade, which may be the result of an increased tendency to seek help, or increased antibiotic resistance and virulence of Staphylococcus aureus. Further microbiological research on the marked regional difference in incidence may contribute to understanding the factors that determine the spread of impetigo. Trends in prescribing for impetigo generally follow evidence-based knowledge on the effectiveness of different therapies, rather than the national practice guideline.

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    • "Our outbreak peaked early summer in May, and lasted from March until August, with one last case in November. It seems unlikely that this outbreak can be linked to the yearly increase in impetigo cases that is seen in day-care centres and nurseries in late summer, since our outbreak didn’t peak in late summer [1,2,17]. "
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    ABSTRACT: Background We describe an outbreak of Bullous Impetigo (BI), caused by a (methicillin susceptible, fusidic acid resistant) Staphylococcus aureus (SA) strain, spa-type t408, at the neonatal and gynaecology ward of the Jeroen Bosch hospital in the Netherlands, from March-November 2011. Methods We performed an outbreak investigation with revision of the hygienic protocols, MSSA colonization surveillance and environmental sampling for MSSA including detailed typing of SA isolates. Spa typing was performed to discriminate between the SA isolates. In addition, Raman-typing was performed on all t408 isolates. Results Nineteen cases of BI were confirmed by SA positive cultures. A cluster of nine neonates and three health care workers (HCW) with SA t408 was detected. These strains were MecA-, PVL-, Exfoliative Toxin (ET)A-, ETB+, ETAD-, fusidic acid-resistant and methicillin susceptible. Eight out of nine neonates and two out of three HCW t408 strains yielded a similar Raman type. Positive t408 HCW were treated and infection control procedures were reinforced. These measures stopped the outbreak. Conclusions We conclude that treatment of patients and HCW carrying a predominant SA t408, and re-implementing and emphasising hygienic measures were effective to control the outbreak of SA t408 among neonates.
    Full-text · Article · Nov 2012
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    • "In the Netherlands, impetigo is the third most common skin disorder in children presented to the general practitioner (GP) (Koning et al., 2006a). Two surveys performed in Dutch general practice showed a geographical gradient in the incidence of impetigo (Koning et al., 2006a). The twofold higher incidence in the south compared with the north was striking, especially for a small country like the Netherlands, although the difference in flowering of fruit trees between south and north is considerable. "
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    ABSTRACT: Impetigo is a common contagious skin infection, mostly seen in children and caused by Staphylococcus aureus and/or group A B-hemolytic Streptococcus. Two surveys performed in general practice showed a strong geographical gradient in the incidence rates among children in the Netherlands. The incidence in the south was approximately twice as high as in the rest of the Netherlands. We hypothesized that this difference could be explained by differences in the presence of animal farms and differences in temperature. This study examined whether there is a relationship with the numbers of bovines, pigs, sheep, and poultry per km2, and temperature, which could explain the observed regional gradient in the incidence of impetigo. In this ecological study, data on the incidence of impetigo in children 0-17 years of age from the second Dutch national survey were linked to data on the density of farm animals from Statistics Netherlands and temperature data from the Dutch Metereological Service. Using logistic regression allowing for overdispersion, we tested the significance of the effect of bovines, pigs, sheep, and poultry per km2, and temperature on the incidence of impetigo, correcting for known risk factors. Only the number of sheep at the (COROP) regional level was significant; however, this effect could not explain the regional differences. The regional differences in the incidence of impetigo in children cannot be explained by the variation in the presence of farm animals or differences in temperature.
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    ABSTRACT: Mit dem Ziel, für Forscher und Verantwortliche für die Erstellung von Gesundheitsversorgungspolicen aktuelle Informationen über die Rolle der Allgemeinmedizin im niederländischen Gesundheitsversorgungssystem zu erhalten, wurde im Jahre 2001 eine zweite niederländische Untersuchung zur Allgemeinmedizin durchgeführt. Die Daten wurden auf verschiedenen Ebenen gesammelt (Patienten, Haus-/Allgemeinärzte, Praxen) und beinhalteten Morbidität (Selbsteinschätzung und Angaben gegenüber Hausärzten), diagnostische und therapeutische Interventionen, die Arzt-Patient-Kommunikation sowie Hintergrundcharakteristika. Verglichen mit 1987 (der ersten nationalen Untersuchung) haben die niederländischen Hausärzte ihre Arbeit wirtschaftlicher organisiert. Die Patienten sind weniger zufrieden (78% zufrieden) mit den organisatorischen Aspekten der allgemeinärztlichen Versorgung als mit der tatsächlich geleisteten Versorgung (90% zufrieden). Die niederländischen Hausärzte liefern eine qualitativ hochwertige Versorgung: Im Durchschnitt stimmt ihre Leistung in 74% mit den nationalen Richtlinien überein. Im Vergleich zu 1987 war die Kommunikation in der Allgemeinmedizin weniger sozial und mehr medizinisch orientiert. Die Torwächterrolle der Haus-/Allgemeinärzte ist noch aktuell; dies wird dadurch veranschaulicht, dass 96% der Kontakte allein durch die Hausärzte abgewickelt werden.
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