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Don’t bother with blood cultures for uncomplicated pediatric SSTIs


 

FROM PEDIATRICS

Blood cultures did not improve the assessment of children hospitalized with uncomplicated skin and soft tissue infections, based on data from a review of more than 500 children. The findings were published online Aug. 5 in Pediatrics.

Some current guidelines suggest obtaining blood cultures from children with skin and soft tissue infections (SSTIs) to help identify bacteremia and prevent sepsis, but the value of the test is unknown and evidence to support its use is limited, said Dr. Jay R. Malone of the University of Oklahoma, Oklahoma City, and colleagues.

The researchers compared 482 children with uncomplicated SSTIs and 98 children with complicated SSTIs (cSSTIs) who were admitted to a single hospital between Jan. 1, 2007, and Dec. 31, 2009, for cellulitis or abscesses. The average age of the children with SSTIs was 3 years, approximately half were male. The average age of the cSSTI children was significantly older (6 years) and included significantly more males (64%). Approximately half of the children in both groups had received at least one dose of antibiotics prior to hospital admission, and about one quarter of children in both groups presented with temperatures greater than 37.9 degrees Celsius.

Overall, none of the 482 children with uncomplicated SSTIs had positive blood cultures (although 3 were contaminated), compared with 10 positive cultures (12.5%) among 98 children with cSSTIs (Pediatrics 2013 Aug. 5 [doi: 10.1542/peds.2013-1384).

However, blood cultures were significantly more frequent for children with uncomplicated SSTIs compared to those with cSSTIs (94% vs. 82%), and those who had blood cultures were significantly more likely than were those who did not have cultures to have a C-reactive protein drawn (98% vs. 74%).

"This could be a result of a greater percentage of children with cSSTI being admitted to surgical services that may perform laboratory investigations less often than medical services," the researchers noted.

The most common infection sites for the uncomplicated SSTI group were the extremities (32%) and buttocks or perineum (27%), while the most common infection sites for the cSSTI group were the face or neck (39%) and extremities (24%).

Overall, the average length of hospital stay was 3 days for children with uncomplicated SSTIs, compared with 7 days for those with cSSTIs. However, the average length of hospital stay was almost a day longer for children with uncomplicated SSTIs who had blood cultures, compared with those who did not (.91 days; a significant difference).

The study was limited by several factors, including the retrospective design, the impact of antibiotics on the blood cultures, and the limited population of children who presented to an emergency department with SSTIs and were admitted to the hospital. Yet the results show that blood cultures in children with uncomplicated SSTIs yield a very low number of positive results, and do not appear to provide clinical value, the researchers said.

"Given the limited value of these tests, physicians might reasonably limit their use to children with complicated infections," they noted.

More research is needed on several fronts, including studies to define the criteria for hospitalizing children with SSTIs and to determine the risk of bacteremia in infants younger than 60 days, they added.

The researchers had no financial conflicts to disclose.

hsplete@frontlinemedcom.com

On Twitter @hsplete

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