72 - The Prevalence of SBI in Infants 60 Days or Younger Presenting to the Pediatric Emergency Department with SSTI.

Poster Number: 72
Publication Number: 72.105

Danielle A. Sweetnam Holmes, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States; John Stockton, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States; Lea Cohen, Maimonides Medical Center, Brooklyn, NY, United States; Antonios Likourezos, Maimonides Medical Center, Brooklyn, NY, United States; Gary Maida, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States; Hector Vazquez, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States

Background: Physicians are frequently faced with the decision to initiate an invasive and emotionally taxing evaluation for serious bacterial infections (SBI); bacteremia, urinary tract infection, and meningitis, in seemingly well infants who present to the Emergency Department with skin and soft tissue infections (SSTI). Historically, a full sepsis workup was recommended, as prior to 1996 pregnant women were not routinely screened/treated for group B streptococcus (GBS). At this time SSTI from GBS had a concurrent SBI rate as high as 90%. Recently this prevalence of a concurrent SBI with a localized skin infection has been suggested to be much lower at 0.58%-2%. Thus, more information is required to better guide clinicians in the management of this population.

Objective: The objective of this study was to look at the prevalence of SBI in infants < 60 days presenting to the emergency department for evaluation of SSTI.

Design/Methods: We conducted a retrospective cohort study from 2009-2019, using the ICD 9/10 codes indicating SSTI. A total of 515 charts were reviewed, 305 were excluded and 210 charts were then separated based on age < 28d and 29-60d and each chart was reviewed for lab work, cultures, antibiotic choice, and disposition.

Results: The overall prevalence of SBI in infants under 60d presenting with SSTI was 7.6%. Of 210 patients included 134(63%) were under 28d with an overall prevalence of SBI of 6.7%. Of the 76(36%) patients 29-60d the overall prevalence of SBI was 9.2%. Of the 134 patients under 28d, 117(87%) had no fever and the positivity rate for the blood culture was 2.5%(3) and of the 13(10%) that had a fever, the positivity rate was 7.3%(1). The most common organism identified from the blood cultures was Staph aureus 75%(3). For the patients under 28d with no fever(118) the positivity rate of the urine culture was 1.6%(2), whereas the 11 who had a fever, and the positivity rate was 21%(3). Of the 76 patients 29-60d, the positivity rate of blood cultures with no fever was 3.7%(2) whereas with a fever the positivity rate was 9%(2). For this same group of 76 patients, 29-60d, the urine culture was positive in 1.9%(1) without fever and 9%(2) with fever. CSF sampling was performed in 9 patients under 28d, and 11 patients 29-60d, and no pathogens grew. Conclusion(s): The prevalence of positive blood cultures and urine cultures in both age cohorts do suggest that blood and urine should be done as the rate of concurrent infection is not non-significant.  The findings of this study added to the growing body of literature will help guide the management of infants presenting with localized SSTI.
Danielle_A.S._Holmes_CV_2021_ Final 2.pdf
Table 2: Culture results presented as a proportions stratified by age and presence of fever.