Source:

Lopez
MA
,
Hall
M
, et al
.
Invasive bacterial infections in infants younger than 60 days with skin and soft tissue infections
.
Pediatr Emerg Care
.
2021
;
37
(
6
):
e301
-
e306
; doi:
https://doi.org/10.1097/PEC.0000000000001584

Investigators from multiple institutions conducted a retrospective cohort study to determine the frequency of invasive bacterial infection (IBI) in infants with skin and soft-tissue infections (SSTI). Infants were eligible if they were: (a) <60 days of age; (b) visited 1 of 35 EDs that contribute data to the Pediatric Health Information System (PHIS) between 2009–2014; and (c) were assigned a primary ICD-9 code for SSTI (eg, cellulitis, abscess, mastitis) or a secondary diagnosis of SSTI and a primary diagnosis of fever, IBI, urinary tract infection (UTI), or anal fistula. Infants with complex chronic conditions were excluded. Demographics as well as clinical characteristics of the ED visit (eg, site of SSTI, presence of fever, IBI or UTI diagnostic testing, and blood, urine, cerebrospinal fluid [CSF] cultures results if obtained) were abstracted from the PHIS database.

The primary outcome was frequency of IBI, defined as bacteremia/sepsis, meningitis, osteomyelitis, or pyogenic arthritis and identified using ICD-9 codes. Secondary outcomes included hospital admission and readmissions with a diagnosis of IBI within 30 days of the initial ED visit. Investigators calculated rate of IBIs among those with SSTI and used chi-squared tests to determine the association of IBIs with demographics and clinical characteristics.

There were 2,734 infants included in analysis. The median age of participants was 33 days, and most were male and had public insurance. The most common sites of SSTI were buttock (34.7%) and breast (21.5%). Overall, 3.4% of infants had fever.

Evaluation for IBI or UTI occurred in 62.4% of infants with SSTI, with blood cultures obtained in 56.3%, urine cultures in 31.7%, and CSF cultures in 24.9%. IBI was identified in 2.0% (N = 56): 1.8% with bacteremia/sepsis, 0.1% with meningitis, and 0.1% with osteomyelitis. UTI was identified in 0.6% (N = 16). There was a significantly higher proportion of infants with IBI or UTI who were 0-28 days old (vs 29-59 days old) and with public (vs private) insurance. There was no significant difference in IBI or UTI diagnosis between those with or without fever. Most (61.8%) participants were admitted to the hospital, with a significantly higher proportion hospitalized who received (vs didn’t receive) IBI or UTI diagnostic testing. Readmissions occurred in 0.18% (N = 5), with 4 having bacteremia and 1 having meningitis.

The investigators conclude that IBI occurs infrequently in infants younger than 60 days presenting to the ED with SSTI.

Dr Bechtel has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

ED visits for children and infants with SSTI have increased over the past 10 years. In addition, hospital admissions for children and infants with SSTIs have nearly...

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