766 - Five-year trends in pediatric skin and soft tissue bacterial culture results in the emergency departments across a large academic healthcare system.
PGY-2 Resident, Department of Pediatrics Yale School of Medicine Yale School of Medicine New Haven, Connecticut, United States
Background: Skin and soft tissue infections (SSTIs) are among the most common reasons for evaluation in the pediatric emergency department (ED). Although superficial and deep wound cultures can guide diagnosis and treatment of SSTI infections, the results of these tests are rarely available to the clinician deciding on appropriate treatment options. Describing the epidemiology of the responsible pathogens and its trend over time can help guide clinical management.
Objective: To describe the results of skin and soft tissue bacterial cultures for children with skin and soft tissue infections evaluated in the ED.
Design/Methods: We conducted a cross-sectional study of children and adolescents aged <21 years evaluated in 5 EDs within a single health system who had a superficial and/or deep wound culture obtained in the ED between 2016-2020. Culture results were grouped in the following categories: Staphylococcus aureus, coagulase-negative Staphylococcus, Streptococcus species, other Gram-positive bacteria, Gram-negative bacteria, mixed cultures and normal flora/no growth. For each year, we calculated the proportion of all culture results that belonged to each group and created stacked bar graphs to illustrate the trends across time. Time trends were evaluated using a Difference-Sign test.
Results: Over the 5-year study period, we identified 857 superficial and deep wound cultures obtained from 813 unique patients. Staphylococcus aureus was the most commonly isolated pathogen across all years, with a prevalence decreasing from 65.3% (62/95) in 2016 to 49.1% (82/167) in 2020 (Figure). Streptococcus prevalence was low across all years (range 2.8%-7.6%). Non-Staphylococcus or Streptococcus Gram-positive bacteria and Gram-negative bacteria accounted for 0.9% (8/857) and 2.9% (25/857) of all cultures, respectively. Overall, 37.2% (319/857) of all cultures yielded non-pathogenic results (coagulase-negative Staphylococcus species, mixed flora or normal skin flora), increasing from 24.2% (23/95) in 2016 to 45.5% (76/167) in 2020, a statistically significant trend (P=0.01). Conclusion(s): There was a statistically significant increase in the proportion of non-pathogenic bacterial cultures in children and adolescents presenting to the ED with suspected SSTIs. Staphylococcus aureus remains the most commonly isolated pathogen. Prior knowledge of these pre-test probabilities can help guide local antibiotic choices in the management of SSTIs in the pediatric ED.
Pathogens identified in superficial and deep wound bacterial cultures in children with SSTIs.
Authors/Institutions: Sofia Grigoria Athanasopoulou, Yale-New Haven Hospital, New Haven, Connecticut, United States; Matthew Grossman, Yale School of Medicine, New Haven, Connecticut, United States; Paul L. Aronson, Yale School of Medicine, Guilford, Connecticut, United States; Jaspreet Loyal, Yale School of medicine, New Haven, Connecticut, United States
