title: Association between skin diseases and severe bacterial infections in children: case-control study.
abstract: BACKGROUND
  Sepsis or bacteraemia, however rare, is a significant cause of high mortality and serious complications in children. In previous studies skin disease or skin infections were reported as risk factor. We hypothesize that children with sepsis or bacteraemia more often presented with skin diseases to the general practitioner (GP) than other children. If our hypothesis is true the GP could reduce the risk of sepsis or bacteraemia by managing skin diseases appropriately.
  
  
  METHODS
  We performed a case-control study using data of children aged 0-17 years of the second Dutch national survey of general practice (2001) and the National Medical Registration of all hospital admissions in the Netherlands. Cases were defined as children who were hospitalized for sepsis or bacteraemia. We selected two control groups by matching each case with six controls. The first control group was randomly selected from the GP patient lists irrespective of hospital admission and GP consultation. The second control group was randomly sampled from those children who were hospitalized for other reasons than sepsis or bacteraemia. We calculated odds ratios and 95% confidence intervals (CI). A two-sided p-value less than 0.05 was considered significant in all tests.
  
  
  RESULTS
  We found odds ratios for skin related GP consultations of 3.4 (95% CI: [1.1-10.8], p = 0.03) in cases versus GP controls and 1.4 (95% CI: [0.5-3.9], p = 0.44) in cases versus hospital controls. Children younger than three months had an odds ratio (cases/GP controls) of 9.2 (95% CI: [0.81-106.1], p = 0.07) and 4.0 (95% CI: [0.67-23.9], p = 0.12) among cases versus hospital controls. Although cases consulted the GP more often with skin diseases than their controls, the probability of a GP consultation for skin disease was only 5% among cases.
  
  
  CONCLUSIONS
  There is evidence that children who were admitted due to sepsis or bacteraemia consulted the GP more often for skin diseases than other children, but the differences are not clinically relevant indicating that there is little opportunity for GPs to reduce the risk of sepsis and/or bacteraemia considerably by managing skin diseases appropriately.
authors.affiliation: Department of General Practice, Room FF 304, Erasmus MC-University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. s.mohammedamin@erasmusmc.nl
authors.forename: Robbert S A
authors.initials: RS
authors.lastname: Mohammedamin
authors.forename: Johannes C
authors.initials: JC
authors.lastname: van der Wouden
authors.forename: Sander
authors.initials: S
authors.lastname: Koning
authors.forename: Sten P
authors.initials: SP
authors.lastname: Willemsen
authors.forename: Roos M D
authors.initials: RM
authors.lastname: Bernsen
authors.forename: François G
authors.initials: FG
authors.lastname: Schellevis
authors.forename: Lisette W A
authors.initials: LW
authors.lastname: van Suijlekom-Smit
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000150:complications / Q000453:epidemiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D012871:Skin Diseases / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology