Prospective evaluation of the management of moderate to severe cellulitis with parenteral antibiotics at a paediatric day treatment centre

Abstract

Treatment with parenteral antibiotic at a DTC is a viable alternative to hospitalisation for moderate to severe cellulitis in children.

Blood Cultures in the Evaluation of Uncomplicated Skin and Soft Tissue Infections

“…Obtaining a blood culture during an episode of SSTI is common practice, particularly in children who are admitted to the hospital for treatment with intravenous antibiotics. 2,5 The rate of bacteremia in immunocompetent children with SSTIs is not known. In the pre-Haemophilus influenzae vaccine era, the rate of SSTI-associated bacteremia was ∼20%, 6 but after introduction of the H. influenzae vaccine, the rate decreased to 2%.…”

Treatment of Skin and Soft Tissue Infections in a Pediatric Observation Unit

“…A few studies address the treatment of pediatric SSTIs in an OU setting. [6][7][8] Although predictors of OU success and failure in patients admitted with SSTIs have been described in the adult literature, [9][10][11] we found no such studies in children. The objective of our study was to report the success rate of OU treatment of pediatric SSTIs and to see if we could identify variables at the time of initial evaluation that predicted successful OU treatment.…”

Failure of Emergency Department Observation Unit Treatment for Skin and Soft Tissue Infections

“…With a growing number of EDs using adjacent OUs, SSTI management has been attempted to monitor progress of the equivocal cellulitis vs. abscess, or to provide several doses of i.v. antibiotic as a ''jump start'' for therapy for cellulitis or abscess (14,15,29). In adults, conversion from OU to inpatient hospitalization is as high as 38%, substantially higher than other conditions such as chest pain, asthma, and pneumonia (29).…”

“…Though not treated in an adjacent OU, Kam et al found that short-term i.v. therapy for cellulitis lasting < 23 h in children was associated with a twofold increase in return visits and re-admission, suggesting that this condition may not be optimal for short stay or observation therapy (14,15). A single pediatric ED study by Lane et al specifically evaluated treatment of SSTI in an OU (30).…”

“…However, conflicting literature exists regarding the effectiveness of short-term i.v. antibiotics, or even, indication for antibiotic therapy in some SSTIs (14)(15)(16)(17). Monitoring for progression of cellulitis possesses potential for successful OU admission, though progression to abscess is undesirable.…”