Non-bullous Impetigo

Impetigo is a common skin infection in children. The worldwide prevalence in
children is estimated to be 12%, but this may be lower since high-income countries
are under-represented. This research aims to evaluate the incidence, prevalence,
and management of children with non-bullous impetigo (NBI) residing in Italy. This
retrospective cohort study included children up to 14 years of age enrolled in the Pedianet
database from January 2004 to June 2018. Events were identified searching ICD9-CM
codes (684 and 694.3) and free text fields for a diagnosis of NBI reported during a primary
care visit. Diagnoses were manually validated, and events registered within 30-days after
the index date were considered follow-ups. Incidence (IR) and prevalence (PR) rates of
NBI were stratified by sex, age group, and calendar year. Topical and systemic antibiotic
treatments were grouped based on ATC codes. 15,136 NBI episodes occurred in a
total cohort of 225,979 children. The overall IR of NBI was 9.5 per 1,000 person-years,
and children aged 1–4 years had the highest IR (13.2 per 1,000 person-years). A
significant decrease in NBI IR from 13 per 1,000 person-years in 2004 to 7.46 per
1,000 person-years in 2018 (p < 0.0001) was noted. Most of the episodes were treated;
systemic antibiotics were preferred over topical.
Conclusion: The prevalence of NBI in children in Italy is less than one third than the
global estimate and the trend in time is decreasing. Over prescriptions of systemic
antibiotics pose a threat to the diffusion of antimicrobial resistance.