Soft Tissue Infections In Children Research Articles

Clinical characteristics and treatment outcomes of skin and soft tissue infections in children: a prospective study

ABSTRACT Backgroundː This study addresses the elevated prevalence of skin and soft tissue infections (SSTIs) within the pediatric demographic, necessitating a comprehensive inquiry into their varied clinical manifestations. The primary objectives involve the assessment of clinical and laboratory characteristics of SSTIs in children and an exploration of their correlation with treatment efficacy. Methodsː From April 2022 to June 2023, a prospective observational study was conducted on 87 pediatric bacterial SSTI cases at a Tertiary Paediatric Centre in Central Vietnam. Resultsː SSTIs were most common in children ages 1-4, 48.3%. Seasonal trends showed a peak incidence in summer (43.7%). In 93.1% of patients, febrile presentation and edema predominated. About 40.2% of people had lower extremity involvement. Analysis showed significant rates of severe (73.6%) and purulent (67.8%) SSTIs. Leukocytosis was found in 39.1% of patients, mostly due to 72.4% increased CRP. Even though only 2.4% of blood cultures were positive, Staphylococcus aureus caused 76.9% of infections. About 42.5% of patients had shorter treatments. Significantly, purulent SSTIs required longer antibiotic therapy than nonpurulent infections (p < 0.05). 27.6% of children needed surgery, and most received intravenous antibiotics. Most importantly, all patients recovered. Conclusionsː Predominantly observed among pediatric cases were purulent SSTIs, exhibiting a proclivity for the lower limbs, with Staphylococcus aureus as the predominant etiological agent. Treatment duration for purulent SSTIs exceeded that for nonpurulent infections. Intravenous antibiotic administration emerged as the predominant therapeutic modality, yielding favorable outcomes.

Microbiological analysis of skin and soft tissue infections in children presenting to a paediatric tertiary care centre in Sri Lanka

Introduction: Skin and soft tissue infections (SSTIs) are a common cause of hospitalisation in children. They are diverse in spectrum, ranging from impetigo and abscesses to life threatening necrotising infections. The main pathogens associated with SSTIs are Staphylococccus aureus and Streptococcus pyogenes. Emergence of community acquired methicillin resistant S. aureus (CA-MRSA) is of major concern when antibiotics are required, and it is important to know the prevalence of these pathogens in different geographic locations. This study was done with the aim of identifying and characterising the common bacterial pathogens implicated in SSTIs in children presenting to Sirimavo Bandaranaike Children’s Hospital (SBSCH), Peradeniya, Sri Lanka, which is one of the two paediatric referral hospitals in Sri Lanka.Method: A retrospective, descriptive study analysed data gathered from request forms accompanying pus and tissue sent for culture from patients with SSTIs to the SBSCH microbiology laboratory during a period of 13 months from January 2021 to January 2022.Results: Two hundred and ninety samples were received from suspected SSTIs of which 197 (67.9%) were positive for bacterial growth, with S. aureus present in 163 (83%). Methicillin resistant S. aureus (MRSA) was isolated from 113 (57%) and methicillin sensitive S. aureus (MSSA) from 50 (25%). The frequency of coliforms, Pseudomonas spp., and Group A streptococcus were 31 (16%), 3 (1.5%) and 4 (2%) respectively. Sensitivity of MRSA isolates to cotrimoxazole, clindamycin, ciprofloxacin and erythromycin were 97%, 86%,72% and 29% respectively. Among MSSA isolates, 94% were sensitive to cotrimoxazole, while sensitivity to clindamycin, ciprofloxacin and erythromycin were 74%, 67% and 40% respectively.Conclusion: MRSA was the most frequent pathogen associated with purulent SSTIs in children, followed by MSSA. One fourth of MSSA were resistant to ciprofloxacin and clindamycin. Ciprofloxacin and clindamycin resistance in MRSA was 15% and 28% respectively.

Life-Threatening Streptococcal Soft Tissue Infections in Children with Chickenpox: A Post-COVID-19 Case Series

Abstract Objective Children with chickenpox complicated by soft tissue infections can become critically unwell. We investigated cases that were referred to our center to examine the role of medical and surgical management in their care. Methods Children presenting with severe soft tissue infections (SSTIs) associated with varicella infections to a tertiary children's hospital in London serving the South East of England were identified. A retrospective review of the patients' records was performed. Results Ten patients presented having developed severe fever and localized cellulitis at around day 4 of their varicella infection. Group A Streptococcus (GAS) was identified as the causative organism in 90% of cases. Every patient required surgical intervention in addition to medical therapy to establish control of their soft tissue infection. We report 100% survival, and no patients required further reconstructive surgery. Conclusion SSTIs, often caused by invasive GAS, can severely complicate otherwise innocuous cases of chickenpox. Failure to respond to maximal medical therapy should prompt urgent referral to a specialist center, and early surgical intervention can prevent progression to more serious illness.

Bacterial Skin and Soft Tissue Infections in Children

Bacterial Skin and Soft Tissue Infections in Children

Things We Do For No Reason: Blood Cultures for Uncomplicated Skin and Soft Tissue Infections in Children.

Skin and soft tissue infections (SSTIs) are common pediatric diagnoses in both outpatient and inpatient settings. Blood cultures are frequently obtained for evaluation of SSTIs. Multiple studies have demonstrated that blood cultures rarely demonstrate true pathogenic bacterial growth, and even positive cultures do not change clinical management. Obtaining blood cultures has been associated with increased length of hospital stay. In addition, false-positive blood cultures may occur and result in repeat blood cultures and increased hospital charges. Clinicians should avoid obtaining blood cultures in pediatric patients with uncomplicated SSTIs but instead should focus on obtaining wound cultures when possible.

Standardizing Care for Skin and Soft Tissue Infections in Children: Impact on Antimicrobial Stewardship

Standardizing Care for Skin and Soft Tissue Infections in Children: Impact on Antimicrobial Stewardship

Multiple Pneumatoceles in a 6-Week-Old Infant

Methicillin-resistant Staphylococcus aureus (MRSA) usually causes skin and soft tissue infections in children and is occasionally associated with hospital-acquired pneumonias, but in recent years, there has been an increase in the incidence of community-acquired MRSA pneumonia. We report a case of community-acquired Panton-Valentine leukocidin secreting MRSA necrotizing pneumonia in a previously well 6-week-old infant, who presented with multiple pneumatoceles. This case highlights the possibility of emerging community-acquired MRSA pneumonia in healthy infants.

Commentary on "Fingernail Carriage of Methicillin-Resistant Staphylococcus aureus and Possible Correlation with Soft Tissue Infections in Children".

Commentary on "Fingernail Carriage of Methicillin-Resistant Staphylococcus aureus and Possible Correlation with Soft Tissue Infections in Children".

Fingernail Carriage of Methicillin-Resistant Staphylococcus aureus and Possible Correlation with Soft Tissue Infections in Children.

Community-associated methicillin-resistant Staphylococcus aureus (MRSA) is a growing problem in the pediatric population, causing many soft tissue infections. This study was designed to examine fingernail carriage of MRSA in children and their caregivers as a possible link to community-associated MRSA soft tissue infections in children. We documented the prevalence of MRSA under the fingernails of children and the caregivers of pediatric patients with soft tissue infections and compared the prevalence with MRSA under the fingernails of children and the caregivers of children with no history of soft tissue infections. Children with soft tissue infections and their caregivers (50 subjects) had three fingernails of each hand swabbed and plated and these were compared with a control group of children and their caregivers (150 subjects) who had no history of MRSA or soft tissue infection. Caregivers and children in the study group were more likely than caregivers and the children in the control group to have MRSA under their fingernails (P < 0.05). Soft tissue infections in the study group were found most commonly in the diapering area (66%). MRSA carriage was evident under the fingernails of children and caregivers. Caregivers and their children who have soft tissue infections are more likely to have MRSA growth under fingernails than caregivers or their children who have no history of MRSA or soft tissue infections. Our study suggests that caregivers could be contributing to soft tissue infections in their children.

Clinical and bacteriological efficacy of twice daily topical retapamulin ointment 1% in the management of impetigo and other uncomplicated superficial skin infections.

BackgroundCutaneous bacterial infections are common in children and adults and frequently are caused by Staphylococcus aureus (S. aureus). Treatment failures with topical agents are not uncommon and have been shown to be secondary to bacterial resistance.ObjectiveTo determine clinical and bacteriological efficacy of retapamulin ointment 1% in treatment of patients with cutaneous bacterial infections caused by methicillin-resistant S. aureus (MRSA) and other bacteria.MethodsProspective, nonrandomized, uncontrolled, open label, single center trial conducted between April 2008 and November 2012 that evaluated efficacy of retapamulin ointment 1% in the treatment of impetigo, folliculitis, and other minor soft tissue infections in children and adults. Fifty patients, who presented to a dermatology outpatient clinic and were clinically diagnosed with impetigo, folliculitis, or minor soft tissue infection suitable for treatment with a topical antibiotic, were screened. Thirty-eight patients were enrolled and received treatment: topical retapamulin ointment 1% twice daily for 5 days. Seven patients were MRSA positive and qualified for the primary efficacy population. One patient withdrew due to an adverse event. Clinical and microbiological exams were performed at baseline and follow-up 5 to 7 days later to assess clinical, microbiological, and therapeutic responses. Primary outcome was clinical response at follow-up in primary efficacy population with MRSA isolated as the baseline pathogen. Secondary outcomes included clinical, microbiologic, and therapeutic responses in patients who were culture positive for any species of bacteria.ResultsClinical response at follow-up in the primary efficacy population (MRSA-positive patients) was not sufficiently powered to demonstrate significance; however, outcomes were excellent, with 7 of 7 patients demonstrating clinical success (5 of 7) or clinical improvement (2 of 7) at follow-up. Barring lack of significance due to small total sample size for patients who were culture positive for any species of bacteria (n = 35), overall success rates were favorable for clinical, microbiologic, and therapeutic responses with values of 66%, 97%, and 69%, respectively. Adverse events (AEs) were mild or moderate in severity. No serious AEs were reported.ConclusionSafety profile appears favorable given the low number of AEs. Study design limits conclusions that can be drawn. Nevertheless, this study supports use of topical retapamulin 1% ointment in treatment of cutaneous bacterial infections, particularly those caused by S. aureus, including MRSA.

Emergency general surgery admission proformas: The value of repeated audit to deliver sustained improvements

s / International Journal of Surgery 12 (2014) S13eS117 S95 1097: EMERGENCY GENERAL SURGERY ADMISSION PROFORMAS: THE VALUE OF REPEATED AUDIT TO DELIVER SUSTAINED IMPROVEMENTS Sarah Wheatstone , Brenda Stacey, Kothandaraman Murali. Darent Valley Hospital, Dartford, Kent, UK. Introduction: Clear, accurate and legible medical records are essential elements of good medical practice and prevent medical errors. The assessment and prescription of venous thrombosis (VTE) prophylaxis is a CQUIN target. We reviewed documentation standards before and after introduction of a dedicated emergency general surgery admissions proforma. After further adjustments we twice re-audited improved proformas. Methods: We audited 50 consecutive emergency admission case notes at four different times: April 2011, October 2011, November 2012 and January 2014. Notes were inspected for patient demographics, team contact details, clinical documentation and management plans. Drug charts and handover sheets were also reviewed. Inpatient referrals were excluded. Results: At final audit, significant improvements were found for patient identifying details (71%-100%, p<0.001), VTE risk assessment (2-86%, p<0.001), allergy documentation (87%-100%, p<0.01), and differential diagnosis (87-98%, p<0.05). There were sustained improvements in the recording of admitting doctor, investigations, and prescription of analgesia, anti-emetics and intra-venous fluids. Despite a prompt box, decision to operate and capacity assessment were rarely recorded. Conclusions: A printed proforma can prompt admitting surgeons to capture more information. Re-audit followed by proforma refinement and team education can improve results further. General surgical teams should be engaged in these changes in the documentation process. 1099: SOFTLY SPREADING? THE INCIDENCE OF SOFT TISSUE INFECTIONS IN AN IRISH REGIONAL HOSPITAL David Kennedy , Sarah Phelan, Helen Mohan, Caoimhe Byrne, Niamh Bambury, Ken Mealy. Wexford General Hospital, Co. Wexford, Ireland. Introduction: Soft-tissue infections are a major cause of morbidity and a burden on hospital resources. Internationally, their incidence is rising.1 The main aim of this study was to examine trends in soft-tissue infection at an Irish regional hospital. Methods: A retrospective analysis of a prospectively maintained surgical audit database (based on the Lothian surgical audit system) from January 2000 until December 2012 was performed. Information collected included baseline demographics, number of admissions, length of stay, and rates of surgical intervention. Statistical analysis was performed using Graph Pad Prism 6. Results: In total, therewere 1388 admissions for cellulitis from 2000-2012. Therewas a significant increase in themean number of admissions per year over the study period, with a 53.4% increase from 2000-2003 compared with 2009-2012 (p1⁄40.0286 Mann-Whitney U test). However, the mean length of stay remained unchanged (7.6 days versus 6.5 days, p1⁄4ns). Conclusions: The incidence of soft-tissue infections is rising. This has implications for planning delivery of acute surgical services. Potential approaches include community based care for a suitable subset, and a focus on primary prevention.[1] Lautz TB, Raval MV, Barsness KA. Increasing national burden of hospitalizations for skin and soft tissue infections in children. J Pediatr Surg 2011 Oct; 46(10):1935-41. 1101: IS BILIRUBIN A USEFUL MARKER IN DIAGNOSING APPENDICITIS? Umar Sharif, David Mathews, Ahmed Karim , Michaela Janks, Hannah Boyd-Carson, Tiramula Raju. Heart of England Trust, Birmingham,

Staphylococcus aureus abscesses: methicillin-resistance or Panton-Valentine leukocidin presence?

IntroductionPanton-Valentine leukocidin (PVL) is a toxin associated with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) worldwide and also occurs in community-associated methicillin-susceptible S aureus (CA-MSSA) strains. The aims of the study were...

Characteristics of Children Referred for Drainage of Sub-cutaneous Soft Tissue Infections

Purpose: Severe skin and soft tissue infections in children are a common cause of hospital admission. Surgical drainage is often required for definitive therapy. Our aim was to review common characteristics of children requiring surgical incision and drainage (I&D) for subcutaneous abscesses. Methods: IRB approval was obtained for a retrospective chart review of children requiring I&D of subcutaneous abscesses between July 2006 and June 2011. Data points included patient demographics, abscess location, surgical procedure, microbiology cultures, and hospital length of stay. Results: Surgical I&D were performed on 1042 children, and 781 patients (75%) were admitted to the surgical service. The average age was 3.4 years. 605 patients (58%) were female. 637 abscesses (61%) were located in the groin/buttock/perineum area. Methicillin-resistant Staphylococcus aureus (MRSA) was identified in 70% of the culture specimens. The average length of stay was 2.8 days. The rate of recidivism was 10.9%. Conclusions: Soft tissue infections requiring hospital admission and I&D are common in the pediatric population. The vast majority of these are due to MRSA infections. Infections requiring drainage most frequently occurred in the diaper area of girls less than 3 years old. A significant number of children have recurrent skin infections and represent an important patient subpopulation.

Carriage of virulence factors and molecular characteristics ofStaphylococcus aureusisolates associated with bloodstream, and skin and soft tissue infections in children

We investigated the virulence gene carriage and molecular type characteristics of Staphylococcus aureus isolates from bloodstream infections (BSIs) and skin and soft tissue infections (SSTIs) in children. A total of 71 isolates, 16 of which were methicillin-resistant S. aureus (MRSA), were investigated by PCR for virulence-associated gene profiles, sequence type and spa type. This revealed that 76.7% and 53.7% of the SSTI and BSI isolates, respectively, exhibited simultaneous carriage of o10 virulence genes. Compared to BSI isolates, carriage rates for hla, hlb, cna, clfA, seb, sec and pvl genes were significantly higher in SSTI isolates. By contrast, carriage of eta, etb and sea was significantly higher for BSI isolates. Thirty-four sequence types (STs) and 36 spa types were identified in the 71 isolates and included 14 novel STs and four novel spa types. ST59-MRSA-IV/V-t437 was the most common clone in the MRSA isolates. We concluded that virulence determinants are widely distributed in isolates of S. aureus strains from children with BSIs and SSTIs, with an unexpectedly high rate in SSTI isolates. Future profiling of S. aureus virulence determinants may allow the prediction of severity and outcome for children with these infections.

Community-Acquired Methicillin-Resistant Staphylococcus aureus Hand Infections in the Pediatric Population

Recent studies have reported rates of methicillin-resistant Staphylococcus aureus (MRSA) hand infections in patients without risk factors ranging from 26% to 73%. The purpose of our study was to review a large series of pediatric hand infections to determine the rate of MRSA and identify potential risk factors. A retrospective review was performed on patients younger than 15 who were seen for hand infections (2001-2010). Patients were categorized according to medical problems, need for operation, abscess location, and mechanism of injury. Potential MRSA risk factors were assessed using a multivariate-regression model. During the 10-year period, 415 patients were seen for hand infections. A total of 146 patients met the inclusion criteria: patients younger than 15 years of age who presented to the plastic surgery service requiring consultation for hand infections. The overall prevalence of MRSA-positive cultures was found to be 30%. The prevalence of MRSA was 29% in healthy patients and 0% in immunocompromised patients. The prevalence of MRSA increased in a linear fashion from patients without documentation of incision and drainage procedures to patients adequately treated with bedside incision and drainage to patients who required surgical drainage. There was a trend toward a higher prevalence of MRSA in deep space abscesses compared to other abscesses. Patients with a history of trauma and previous MRSA infections had a higher rate of MRSA than other patients. Traditionally, MRSA has been associated with hospitalization, intravenous drug use, recent antibiotic use, and compromised immunity. In our study, more severe, deep-space abscesses requiring surgical drainage and patients with a history of previous MRSA infections were found to have a higher prevalence of MRSA. The immunocompromised patients had no cases of MRSA and had higher incidences of less virulent bacterial infections. This suggests that acquisition of community-acquired MRSA skin and soft tissue infections in children and adolescents might not be associated with the traditional risk factors. Prognostic IV.

Increasing national burden of hospitalizations for skin and soft tissue infections in children

Background The number of children requiring treatment of skin and soft tissue infections (SSTIs) has increased since the emergence of methicillin-resistant Staphylococcus aureus. Methods The 2000, 2003, and 2006 Kids' Inpatient Databases were queried for patients with a primary diagnosis of SSTI. Weighted data were analyzed to estimate temporal changes in incidence, incision and drainage (I&D) rate, and economic burden. Factors associated with I&D were analyzed by multivariable logistic regression. Results Pediatric SSTI admissions increased (1) in number, (2) as a fraction of all hospital admissions, and (3) in incidence per 100,000 children from the years 2000 (17,525 ± 838; 0.65%; 23.2) to 2003 (27,463 ± 1652; 0.99%; 36.2) and 2006 (48,228 ± 2223; 1.77%; 62.7). Children younger than 3 years accounted for 49.6% of SSTI admissions in 2006, up from 32.5% in 2000. Utilization of I&D increased during the study period from 26.0% to 43.8%. Factors most associated with requiring I&D were age less than 3 years and calendar year 2006 (both P < .001). Hospital costs per patient increased over time and were higher in the group of patients who required I&D ($4296 ± $84 vs $3521 ± $81; P < .001; year 2006). Aggregate national costs reached $184.0 ± $9.4 million in 2006. Conclusion The recent spike in pediatric SSTIs has disproportionately affected children younger than 3 years, and an increasing fraction of these children require I&D. The national economic burden is substantial.

Cutaneous Gonococcal Abscess of the Abdomen in a Child

Virtually all pediatric cases of Neisseria gonorrhoeae originate from contact with an infected adult. A cutaneous abscess caused by N. gonorrhoeae in a child is extremely rare, especially outside the genital area. We report a case of a 22-month-old boy with a gonococcal cutaneous abscess on the abdominal wall and suggest that N. gonorrhoeae should be included in the differential diagnosis of skin and soft tissue infections in children.

Interexaminer Agreement in Physical Examination for Children With Suspected Soft Tissue Abscesses

This study aimed to measure interexaminer agreement for physical examination (PE) findings in children with a suspected soft tissue abscess. A prospective study was conducted from March 1 to July 31, 2007, at an urban, tertiary care children's hospital emergency department. Children presenting to the emergency department with a suspected local skin abscess were independently examined by 2 physicians. Interrater agreement of 7 PE findings for children with a suspected soft tissue abscess was assessed. Interrater agreement was calculated for the diagnosis of the lesion and decision to incise and drain. A total of 105 paired observations were completed by a total of 27 physicians. The patients examined were aged 2 weeks to 18 years, with a mean age of 80 months. Lesions were most frequently encountered on the buttocks (38%). Incision and drainage was attempted in 75% of cases, with purulent material obtained in 92% of all attempts. Interrater agreement was substantial for erythema (κ = 0.66) and size of the lesion (intraclass correlation coefficient = 0.78), moderate for drainage (κ = 0.57) and tenderness (κ = 0.40), fair for fluctuance (κ = 0.35), and poor for warmth (κ = 0.15) and showed no agreement for induration (κ = -0.08). There was moderate agreement on diagnosing the lesion as an abscess (κ = 0.48) and determination if the lesion required incision and drainage (κ = 0.44). Interexaminer agreement of examination findings and diagnosis of an abscess was fair to moderate, implying a lack of precision of PE as the primary means for diagnosis. Future studies of diagnostic adjuncts, such as bedside ultrasonography, may lead to improved management of soft tissue infections in children.

Mupirocin Resistance in Staphylococcus aureus Causing Recurrent Skin and Soft Tissue Infections in Children

Staphylococcus aureus resistance to mupirocin is often caused by acquisition of a novel isoleucyl-tRNA synthetase encoded on the plasmid gene mupA. We tested S. aureus isolates from children at Texas Children's Hospital with recurrent skin and soft tissue infections for mupirocin resistance and mupA. Of 136 isolates, 20 were resistant to mupirocin (14.7%). Fifteen isolates (11%) carried mupA, and the gene was more common in methicillin-susceptible S. aureus (21.4%) than methicillin-resistant S. aureus (8.3%; P=0.03). Seven of 20 mupirocin-resistant isolates displayed clindamycin resistance.

Children with Atopic Dermatitis Appear Less Likely to Be Infected with Community Acquired Methicillin‐Resistant Staphylococcus aureus: The San Diego Experience

Given the increasing rate of community-acquired methicillin resistant Staphylococcus aureus skin infections in the population, such infections might be concurrently increasing in patients with atopic dermatitis. This study assessed current and prior rates of community-acquired methicillin resistant Staphylococcus aureus and methicillin-susceptible Staphylococcus aureus skin and soft tissue infections in children with atopic dermatitis compared to the general pediatric population. Other antibiotic sensitivity and resistance patterns, including clindamycin-inducible resistance, were also identified. Retrospective study of all skin and soft tissue isolates were positive for Staphylococcus aureus during two distinct 1-year periods, obtained by the outpatient services and the emergency department at Rady Children's Hospital, the major regional pediatric health center in San Diego, California. Of the Staphylococcus aureus isolates obtained from January to December 2000, none from atopic dermatitis patients were methicillin resistant Staphylococcus aureus, while 4.2% of those obtained from the general outpatient pediatric population showed methicillin resistance. In the period from June 2007 to May 2008, 11 of 78 isolates (14.1%) from children with atopic dermatitis were methicillin resistant Staphylococcus aureus. This was significantly lower than the rate of increase noted in the general pediatric population (658 of 1482, or 44.4%, in 2007/2008, p < 0.05). Clindamycin-inducible resistance was noted in 1.9% of the isolates in the general population; all six tested isolates from atopic patients lacked clindamycin-inducible resistance. In this study, children with atopic dermatitis had a much lower rate of community-acquired methicillin resistant Staphylococcus aureus infection compared to the general outpatient pediatric population. Clindamycin-inducible resistance was very low in both groups.