291: Pediatric Cellulitis: Success of Emergency Department Short Course Intravenous Antibiotics

Skin and soft tissue infection management failure in the emergency department observation unit: a systematic review

“…Articles were excluded if patients were observed on an outpatient basis (eg, home care, day treatment centres), or if management failure was defined as re-presentation, or revisit to ED (eg, Kam et al 8). Additionally, studies were excluded if they did not differentiate SSTIs from other conditions in the observation unit.…”

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

“…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).…”

“…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).…”

“…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.…”

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

“…9 In a study of shortcourse intravenous antibiotics for children with cellulitis in a pediatric emergency department, the WBC was not predictive of the need for longer-course antibiotics after multivariate analysis. 12 Blood cultures were obtained in 32.4% of our cohort. Consistent with prior reports, we observed a low yield of likely pathogens from blood culture analysis (2.9%) among children with SSTIs.…”