#29 Skin and Soft Tissue Infections and Associated Complications in Children Aged 0-3 Years in Two Urban Multiethnic Community Hospitals

Abstract

Abstract Background Skin and soft tissue infections (SSTI) include cellulitis and abscess. Cellulitis is an infection of the deep dermis and an abscess is a collection of pus within the dermis and subcutaneous space. Complications of SSTI include bacteremia, lymphadenitis, endocarditis, septic arthritis or osteomyelitis, metastatic infection, sepsis, and toxic shock syndrome. There are no studies evaluating SSTI and complications and outcomes in children aged 0-3 years. Method This is a retrospective chart review of SSTI in children aged 0-3 years in Flushing Hospital Medical Center and Jamaica Hospital Medical Center between Jan 2015 and Oct 2021. Data extracted from EHR include demographics (age, gender, ethnicity), clinical presentation, laboratory studies, imaging studies, antibiotic used, treatment course, complications and length of stay (LOS). Data were analyzed using percentages. Results Of 206 patients admitted for SSTI, about a half (48%) were abscesses, less than half (44%) cellulitis, few impetigo (6%) and staphylococcal scalded skin syndrome (2%). Most were male (52%), Hispanic (70%) and Asian (26%). A fifth (18%) had previous SSTI and a tenth (8%) had a positive family history. Of a third (36%) who had imaging studies, three quarters (76%) had an ultrasound, less than a half (44%) confirmed an abscess and less than a third (29%) soft tissue infection. Almost all (94%) had a blood culture and most a wound culture (59%). Of the positive blood cultures (4%), majority (78%) were contaminants or normal skin flora and remainder (22%) Staphylococcus aureus. Of the positive wound cultures, most (86%) were Staphylococcus aureus. Methicillin-sensitive S. aureus (MSSA) was equal to methicillin-resistant S. aureus (MRSA) (44% vs 43%). Of the 11% having complications, the most common was lymphadenitis (6%). Clindamycin was the antibiotic of choice in most (70%) and 14% required a change in antibiotic due to susceptibility pattern. The median LOS was 3 days. Conclusion The most common SSTI in children aged 0-3 years is abscess and cellulitis. The yield of blood cultures is low. The prevalence of MRSA was equal to MSSA. Knowing the low prevalence of complications in children with SSTI, healthcare providers can provide appropriate antibiotic coverage and disposition for SSTI in our community.