Acute bacterial lymphadenitis in children: a retrospective, cross-sectional study

Abstract

Acute bacterial lymphadenitis is a common childhood condition, yet there remains considerable variability in antibiotic treatment choice, particularly in settings with low prevalence of methicillin-resistant Staphylococcus aureus such as Europe and Australasia. This retrospective cross-sectional study reviewed children presenting with acute bacterial lymphadenitis to a tertiary paediatric hospital in Australia between 1 October 2018 and 30 September 2020. Treatment approaches were analysed with respect to children with complicated versus uncomplicated disease. A total of 148 children were included in the study, encompassing 25 patients with complicated disease and 123 with uncomplicated lymphadenitis, as defined by the presence or absence of an associated abscess or collection. In culture-positive cases, methicillin-susceptible S. aureus (49%) and Group A Streptococcus (43%) predominated, while methicillin-resistant S. aureus was seen in a minority of cases (6%). Children with complicated disease generally presented later and had a prolonged length of stay, longer durations of antibiotics, and higher frequency of surgical intervention. Beta-lactam therapy (predominantly flucloxacillin or first-generation cephalosporins) formed the mainstay of therapy for uncomplicated disease, while treatment of complicated disease was more variable with higher rates of clindamycin use. Conclusion: Uncomplicated lymphadenitis can be managed with narrow-spectrum beta-lactam therapy (such as flucloxacillin) with low rates of relapse or complications. In complicated disease, early imaging, prompt surgical intervention, and infectious diseases consultation are recommended to guide antibiotic therapy. Prospective randomised trials are needed to guide optimal antibiotic choice and duration in children presenting with acute bacterial lymphadenitis, particularly in association with abscess formation, and to promote uniformity in treatment approaches. What is Known:• Acute bacterial lymphadenitis is a common childhood infection.• Antibiotic prescribing practices are highly variable in bacterial lymphadenitis. What is New:• Uncomplicated bacterial lymphadenitis in children can be managed with single agent narrow-spectrum beta-lactam therapy in low-MRSA prevalence settings.• Further trials are needed to ascertain optimal treatment duration and the role of clindamycin in complicated disease.

Evaluation of Staphylococcus aureus Infections in Children

“…In culture-positive cases, MSSA (49%) and Group A Streptococcus (43%) predominated, while MRSA was seen in a minority of cases (6%). Cephalexin, clindamycin, amoxicillinclavulanate, was the most used antibiotics (16). In our study, 28 of the patients (24.1%) had lymphadenitis.…”

Association between the Clinical, Laboratory and Ultrasound Characteristics and the Etiology of Peripheral Lymphadenopathy in Children

“…Clinically, a lump of multiple enlarged lymph nodes is often considered and measured as one. The difference in size detected between the US and clinical evaluation was especially obvious in bacterial lymphadenitis, where swelling of tissues around the lymph node can also contribute to the overestimation of its size [8]. Differences in the size of lymph nodes between the three main etiological groups were more pronounced when evaluated clinically than when measured with US.…”

“…Acute unilateral cervical lymphadenitis is less common than bilateral disease and is usually caused by pyogenic bacteria such as Staphylococcus aureus or GAS. Localized bacterial lymphadenitis can also arise as a response of the draining nodes to local infection in axillary, epitrochlear or inguinofemoral regions [6,8,9].…”

Increase in complicated upper respiratory tract infection in children during the 2022/2023 winter season—a post coronavirus disease 2019 effect?

“…The present study adds to the existing knowledge that not only did the number of imaging studies in children with upper respiratory tract infections increase rapidly after the pandemic, but that these infections also resulted in more complications and that the number of infections caused by streptococcus species increased significantly. Streptococci are pathogens often seen in cohorts of children with abscesses in the head and neck region [ 26 , 27 ].…”