Children Hospitalized with Skin and Soft Tissue Infections

Abstract

Skin and soft tissue infections in children are an important cause for hospitalization. A thorough history and physical examination can provide clues to the pathogens involved. Collection of purulent discharge from lesions should be completed prior to initiating antimicrobial therapy, and results of bacteriologic studies (Gram stain and culture) should guide therapeutic decisions. The main pathogens involved in these infections are Staphylococcus aureus and group A beta-hemolytic streptococci, but enteric organisms also play a role especially in nosocomial infections. Increasing antibacterial resistance is becoming a major problem in the treatment of these infections worldwide. Specifically, the rise of methicillin-resistant S. aureus and glycopeptide-resistant S. aureus pose challenges for the future. Infections of the skin and soft tissues can be broadly classified based on the extent of tissue involvement. Superficial infections such as erysipelas, cellulitis, bullous impetigo, bite infections, and periorbital cellulitis may require hospitalization and parenteral antibacterials. Deeper infections such as orbital cellulitis, necrotizing fasciitis, and pyomyositis require surgical intervention as well as parenteral antibacterial therapy. Surgery plays a key role in the treatment of abscesses and for the debridement of necrotic tissue in deep infections. Intravenous immunoglobulin, as an adjunctive therapy, can be helpful in treating necrotizing fasciitis. For most infections an antistaphylococcal beta-lactam antibacterial is first-line therapy. Third-generation cephalosporins and beta-lactam/beta-lactamase inhibitor antibacterials as well as clindamycin or metronidazole are often required to provide broad-spectrum coverage for polymicrobial infections.Special populations, such as immunocompromised children, those with an allergy to penicillins, and those that acquire infections in hospitals, require specific antibacterial strategies. These usually involve broader antimicrobial coverage with increased Gram-negative (including antipseudomonal) and anerobic coverage. In patients with a true allergy to penicillins, clindamycin and vancomycin play an important role in treating Gram-positive infections. Newer antibacterial agents, such as linezolid and quinupristin/dalfopristin, are increasingly being studied in children for the treatment of skin and soft tissue infections. These agents hold promise for the future especially in the treatment of highly resistant, Gram-positive organisms such as methicillin-resistant S. aureus, vancomycin-resistant S. aureus, and vancomycin-resistant enterococci.

Development of a prediction model for bacteremia in hospitalized adults with cellulitis to aid in the efficient use of blood cultures: a retrospective cohort study

“…Finally, this study was limited to adults. Because of differences in demography, disease co-morbidities, and microbiology, the results of the current study cannot be applied to children [ 20 ].…”

Erysipelas of the child: About 30 cases

“…The classic inflammatory placard is usually found with sometimes local signs (Bubbles, purpura ....) Osteomyelitis and osteoarthritis are the main differential diagnoses of erysipelas in children, especially for the forms located next to the joints, hence the interest of completing a standard radiography to eliminate these orthopedic emergencies. Hospitalization is not always necessary, nevertheless, there are some factors of gravity leading to indicate a hospitalization in urgency [7].…”

Eugenol micro-emulsion reinforced with silver nanocomposite electrospun mats for wound dressing strategies

“…2 The pathogenic microorganisms present on the surface of wound infections are polymicrobial involving both anaerobic and aerobic microbial strains such as Pseudomonas aeruginosa, Staphylococcus aureus and hemolytic streptococci. 3,4 Gram positive bacterium Staphylococcus aureus is found predominant in all types of acute and chronic wound infections and methicillin-resistant Staphylococcus aureus (MRSA) is still increasing at a faster rate and gaining antimicrobial resistance to various synthetic and natural antibiotics resulting in urgent demand of new therapeutics. 5,6 The wound dressings play an important role in the treatment of wound infections.…”