Table 3.

Incidence and Risk Factors Associated with Recurrent Skin and Soft Tissue Infection

Study Reference	Population; Year(s) Study Performed	Study Design	Treatment or Intervention	Longitudinal Timeframe	Proportion of Patients with Recurrent SSTI	Factors Associated with Recurrent SSTI
Bocchini et al, 2013 [104]	12,836 children presenting to Texas Children’s Hospital (TCH; Houston, TX) with community-associated S. aureus infection; 2001–2009	Retrospective cohort study	N/A	76 months	5% presented to TCH with documented recurrent S. aureus infection (694 with recurrent S. aureus infection of any etiology; 637 with recurrent S. aureus SSTI)	Age ≤36 months
Williams et al, 2011 [99]	47,501 children with incident SSTI enrolled in Tennessee Medicaid; 2004–2007	Retrospective cohort study	Treatment with clindamycin, trimethoprim-sulfamethoxazole (TMP/SMX), or a β-lactam antibiotic	365 days	14% overall had a documented recurrent SSTI (23% in patients undergoing drainage; 18% of those without drainage)	In patients undergoing drainage, recurrent SSTI was higher among patients prescribed TMP/SMX or a β-lactam antibiotic In patients without drainage, prescription of TMP/SMX was associated with recurrent SSTI
Chen et al, 2009 [100]	95 children with purulent SSTI in Baltimore, MD; 2006–2007	Subgroup analysis of a double-blind, randomized, controlled trial comparing cephalexin to clindamycin	Treatment with cephalexin or clindamycin (assignment not specified)	3 months	22% reported recurrent SSTI	Baseline MRSA SSTI (compared to baseline MSSA SSTI)
Fritz et al, 2012 [103] [and Fritz unpublished data]	183 children with acute CA-S. aureus SSTI and concurrent S. aureus colonization in St. Louis, MO; 2008–2009	Randomized, controlled trial comparing individual vs. household decolonization	All patients were assigned a 5-day decolonization regimen of enhanced personal and household hygiene, intranasal 2% mupirocin ointment application twice daily, and daily 4% chlorhexidine body washes	12 months	63% reported recurrent SSTI (72% in index decolonization group; 52% in household decolonization group)	Multiple sites of S. aureus colonization at baseline History of SSTI in year prior to study enrollment Younger age Baseline MSSA SSTI (compared to baseline MRSA SSTI) Participants prescribed clindamycin for their baseline SSTI were less likely to have a recurrent infection
Miller et al, 2015 [105]	330 adults and children treated for S. aureus SSTI in Los Angeles, CA and Chicago, IL; 2008–2010	Prospective cohort study	N/A	6 months	51% reported recurrent SSTI	Hospitalization in the prior 3 months Household fomite contamination with MRSA Lack of participation in contact sports
Kaplan et al, 2014 [59]	987 children with suspected S. aureus SSTI or invasive infection in Houston, TX; 2009–2012	Randomized, controlled trial comparing hygienic measures alone vs. hygienic measures plus bleach baths	Participants in the intervention arm bathed in dilute bleach water twice weekly for 3 months	12 months	19% reported medically-attended recurrent SSTI (21% hygiene group; 17% bleach bath group)	Multiple sites of S. aureus colonization at baseline Age ≤1.86 years White race (compared to African-American and Hispanic) Incidence of recurrence did not differ between children with MRSA vs. MSSA baseline infections