692. Association between First Line Antibiotic Treatment of Abscesses and Persistence of Infection
Session: Poster Abstract Session: They've Been Here a Billion Years! Pediatric Bacterial and Viral Infections
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • IDSA 2016 Poster Final.pdf (557.8 kB)
  • Background: Skin and soft tissue infections (SSTIs) are often abscesses, treated with incision and drainage (I&D), followed by antibiotic course. A number of SSTI will fail to improve on this. Trimethoprim-sulfamethoxazole (TMP-SMX) or clindamycin are commonly prescribed antibiotics to treat abscesses. Little is known on cause for persistent SSTIs. We identified factors contributing to persistent infections among children seeking re-evaluation of a previously treated SSTI. We hypothesized that TMP-SMX as a primary antibiotic for treatment of abscesses leads to significant rates of persistent infections, particularly those located below the waist.

    Methods: Retrospective analysis of a large prospective pediatric SSTI study conducted in 3 pediatric EDs. We analyzed data on patients who were re-evaluated for previously treated SSTI. Persistent infection is defined as SSTI presenting >48 hours after previous treatment. Patients were excluded if they had immune deficiency, multiple abscesses, or presented >14 days after initial treatment. Demographic information, past medical history, and details of SSTI were obtained. Details of (1) time between start of prior antimicrobial therapy and SSTI re-evaluation; (2) antibiotics prescribed; (3) body location of SSTI; and (5) I&D culture results. Bivariate and multiple logistic regression analyses were conducted based on covariates of interest determined a priori.

    Results: From June 2013 to January 2015, 378 of 1,013 SSTI were re-evaluated for persistent infection. The average age was 6.59 years. 48.41% (183/378) were White, and 31.22% (118/378) Black. 57.67% (218/378) were female. 31.22% (118/378) were on TMP-SMX therapy at time of re-evaluation, 21.96% (83/378) on Clindamycin, and 16.67% (63/378) on multiple antibiotics. Patients with abscesses located below the waist (60.85%, 230/378) were more likely to be < 5 years (OR 3.60, 95% CI: 2.13-6.10, p value < 0.0001) and on TMP-SMX (OR 3.75, 95% CI: 1.94-7.22, p value < 0.0001) at initial treatment, compared to patients on other antibiotics.

    Conclusion: Majority of SSTI children were re-evaluated while on TMP-SMX or clindamycin. Patients needing SSTI re-evaluation were more likely to be onTMP-SMP, have SSTI located below the waist, and < 5 years of age.

    Anaam Mohammed, MPH, CCRC1, Trisha Parker, MPH, CCRC2, Shaaz Fareed, BS3, Elham Laghaie, BS, MS4 and Lilly Immergluck, MD, MS3, (1)Pediatric Emergency Medicine Associates, LLC, Atlanta, GA, (2)Anglia Ruskin University, Chelmsford, United Kingdom, (3)CRC, Morehouse School of Medicine, Atlanta, GA, (4)CRC, Pediatrics, Morehouse School of Medicine, Atlanta, GA

    Disclosures:

    A. Mohammed, None

    T. Parker, None

    S. Fareed, None

    E. Laghaie, None

    L. Immergluck, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.