Pediatric Infectious Disease

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  6 (2024)
Volume  5 (2023)
Volume  4 (2022)
Volume  3 (2021)
Volume  2 (2020)
Volume  1 (2019)
Related articles

VOLUME 3 , ISSUE 4 ( October-December, 2021 ) > List of Articles

REVIEW ARTICLE

Bacterial Skin and Soft Tissue Infections in Children

Divya Gupta

Keywords : Complicated, Pediatric, Skin and soft tissue infection, Uncomplicated

Citation Information : Gupta D. Bacterial Skin and Soft Tissue Infections in Children. Pediatr Inf Dis 2021; 3 (4):146-155.

DOI: 10.5005/jp-journals-10081-1305

License: CC BY-NC 4.0

Published Online: 27-12-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Skin and soft tissue infections (SSTIs) are common in the pediatric age-group in developing countries, where the risk factors are commonplace. These SSTIs may be classified for ease of management, into uncomplicated (uSSTI) and complicated SSTIs (cSSTI). Folliculitis, furuncles, impetigo, ecthyma, and erysipelas are grouped under uSSTI, whereas abscess, carbuncle, and cellulitis come under cSSTI. Most of them are secondary to Staphylococcus aureus and group I beta-hemolytic Streptococci. Antibiotic treatment must be based on antimicrobial sensitivities and local community resistance patterns. Antibiotics like beta-lactams, first-generation cephalosporins, trimethoprim-sulfamethoxazole, and clindamycin are effective in most patients. However, methicillin-resistant Staphylococcus aureus (MRSA) is a serious concern in cases worldwide, including India. Newer molecules like dalbavancin, telavancin, tigecycline, ceftaroline, and tedizolid are emerging.

HTML PDF Share
  1. Galli L, Venturini E, Bassi A, et al. Common community-acquired bacterial skin and soft-tissue infections in children: an intersociety consensus on impetigo, abscess, and cellulitis treatment. Clin Ther 2019;41(3):532–551.e17. DOI: 10.1016/j.clinthera.2019.01.010.
  2. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis Off Publ Infect Dis Soc Am 2014;59(2):147–159. DOI: 10.1093/cid/ciu444.
  3. Research C for DE and. Acute Bacterial Skin and Skin Structure Infections: Developing Drugs for Treatment [Internet]. U.S. Food and Drug Administration. FDA; 2020 [cited 2020 Oct 24]. Available from: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/acute-bacterial-skin-and-skin-structure-infections-developing-drugs-treatment.
  4. Esposito S, Bassetti M, Concia E, et al. Diagnosis and management of skin and soft-tissue infections (SSTI). A literature review and consensus statement: an update. J Chemother Florence Italy 2017;29(4):197–214. DOI: 10.1080/1120009X.2017.1311398.
  5. Fritz SA, Hogan PG, Hayek G, et al. Household versus individual approaches to eradication of community-associated Staphylococcus aureus in children: a randomized trial. Clin Infect Dis Off Publ Infect Dis Soc Am 2012;54(6):743–751. DOI: 10.1093/cid/cir919.
  6. Davido B, Dinh A, Salomon J, et al. Recurrent furunculosis: efficacy of the CMC regimen–skin disinfection (chlorhexidine), local nasal antibiotic (mupirocin), and systemic antibiotic (clindamycin). Scand J Infect Dis 2013;45(11):837–841. DOI: 10.3109/00365548.2013.810815.
  7. Bowen AC, Mahé A, Hay RJ, et al. The global epidemiology of impetigo: a systematic review of the population prevalence of impetigo and pyoderma. PLoS ONE 2015;10(8):e0136789. DOI: 10.1371/journal.pone.0136789.
  8. Bernard P, Jarlier V, Santerre-Henriksen A. Antibiotic susceptibility of Staphylococcus aureus strains responsible for community-acquired skin infections. Ann Dermatol Venereol 2008;135(1):13–19. DOI: 10.1016/j.annder.2007.06.004.
  9. Taira BR, Singer AJ, Thode HC, et al. National epidemiology of cutaneous abscesses: 1996 to 2005. Am J Emerg Med 2009;27(3):289–292. DOI: 10.1016/j.ajem.2008.02.027.
  10. Hartman-Adams H, Banvard C, Juckett G. Impetigo: diagnosis and treatment. Am Fam Physician 2014;90(4):229–235.
  11. Wiese-Posselt M, Heuck D, Draeger A, et al. Successful termination of a furunculosis outbreak due to lukS-lukF-positive, methicillin-susceptible Staphylococcus aureus in a German village by stringent decolonization, 2002-2005. Clin Infect Dis Off Publ Infect Dis Soc Am 2007;44(11):e88–e95. DOI: 10.1086/517503.
  12. Tinelli M, Monaco M, Vimercati M, et al. Methicillin-susceptible Staphylococcus aureus in skin and soft tissue infections, Northern Italy. Emerg Infect Dis 2009;15(2):250–257. DOI: 10.3201/eid1502.080010.
  13. Golding GR, Levett PN, McDonald RR, et al. A comparison of risk factors associated with community-associated methicillin-resistant and -susceptible Staphylococcus aureus infections in remote communities. Epidemiol Infect 2010;138(5):730–737. DOI: 10.1017/S0950268809991488.
  14. Scheinfeld NS. Is blistering distal dactylitis a variant of bullous impetigo? Clin Exp Dermatol 2007;32(3):314–316. DOI: 10.1111/j.1365-2230.2007.02379.x.
  15. Rush J, Dinulos JG. Childhood skin and soft tissue infections: new discoveries and guidelines regarding the management of bacterial soft tissue infections, molluscum contagiosum, and warts. Curr Opin Pediatr 2016;28(2):250–257. DOI: 10.1097/MOP.0000000000000334.
  16. Mahmoodzadeh Hosseini H, Kiyani N, Amin M, et al. Distribution of high-level mupirocin resistance among clinical MRSA. J Chemother Florence Italy 2017;29(4):215–219. DOI: 10.1080/1120009X.2016.1201257.
  17. Yu F, Liu Y, Lu C, et al. Dissemination of fusidic acid resistance among Staphylococcus aureus clinical isolates. BMC Microbiol 2015;15(1):210. DOI: 10.1186/s12866-015-0552-z.
  18. Nagabushan H. Retapamulin: a novel topical antibiotic. Indian J Dermatol Venereol Leprol 2010;76(1):77–79. DOI: 10.4103/0378-6323.58693.
  19. Hayden MK, Lolans K, Haffenreffer K, et al. Chlorhexidine and mupirocin susceptibility of methicillin-resistant Staphylococcus aureus isolates in the REDUCE-MRSA trial. J Clin Microbiol 2016;54(11):2735–2742. DOI: 10.1128/JCM.01444-16.
  20. McNeil JC, Hulten KG, Kaplan SL, et al. Decreased susceptibilities to retapamulin, mupirocin, and chlorhexidine among Staphylococcus aureus isolates causing skin and soft tissue infections in otherwise healthy children. Antimicrob Agents Chemother 2014;58(5):2878–2883. DOI: 10.1128/AAC.02707-13.
  21. Gropper S, Cepero AL, Santos B, et al. Systemic bioavailability and safety of twice-daily topical ozenoxacin 1% cream in adults and children with impetigo. Future Microbiol 2014;9(8 Suppl):S33–S40. DOI: 10.2217/fmb.14.85.
  22. Chamny S, Miron D, Lumelsky N, et al. Topical minocycline foam for the treatment of impetigo in children: results of a randomized, double-blind, phase 2 study. J Drugs Dermatol JDD 2016;15(10):1238–1243.
  23. Koning S, van der Sande R, Verhagen AP, et al. Interventions for impetigo. Cochrane Database Syst Rev 2012;1:CD003261. DOI: 10.1002/14651858.CD003261.pub3.
  24. Ray GT, Suaya JA, Baxter R. Incidence, microbiology, and patient characteristics of skin and soft-tissue infections in a U.S. population: a retrospective population-based study. BMC Infect Dis 2013;13(1):252. DOI: 10.1186/1471-2334-13-252.
  25. Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the infectious diseases society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis Off Publ Infect Dis Soc Am 2011;52(3):285–292. DOI: 10.1093/cid/cir034.
  26. Bassetti M, Baguneid M, Bouza E, et al. European perspective and update on the management of complicated skin and soft tissue infections due to methicillin-resistant Staphylococcus aureus after more than 10 years of experience with linezolid. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis 2014;20(Suppl 4):3–18. DOI: 10.1111/1469-0691.12463.
  27. Palit A, Inamadar AC. Current concepts in the management of bacterial skin infections in children. Indian J Dermatol Venereol Leprol 2010;76(5):476–488. DOI: 10.4103/0378-6323.69053.
  28. Talan DA, Mower WR, Krishnadasan A, et al. Trimethoprim-sulfamethoxazole versus placebo for uncomplicated skin abscess. N Engl J Med 2016;374(9):823–832. DOI: 10.1056/NEJMoa1507476.
  29. Holmes L, Ma C, Qiao H, et al. Trimethoprim-sulfamethoxazole therapy reduces failure and recurrence in methicillin-resistant Staphylococcus aureus skin abscesses after surgical drainage. J Pediatr 2016;169:128–134.e1. DOI: 10.1016/j.jpeds.2015.10.044.
  30. Miller LG, Daum RS, Creech CB, et al. Clindamycin versus trimethoprim-sulfamethoxazole for uncomplicated skin infections. N Engl J Med 2015;372(12):1093–1103. DOI: 10.1056/NEJMoa1403789.
  31. Daum RS, Miller LG, Immergluck L, et al. A placebo-controlled trial of antibiotics for smaller skin abscesses. N Engl J Med 2017;376(26):2545–2555. DOI: 10.1056/NEJMoa1607033.
  32. Gaspari RJ, Resop D, Mendoza M, et al. A randomized controlled trial of incision and drainage versus ultrasonographically guided needle aspiration for skin abscesses and the effect of methicillin-resistant Staphylococcus aureus. Ann Emerg Med 2011;57(5):483–491.e1. DOI: 10.1016/j.annemergmed.2010.11.021.
  33. Singer AJ, Talan DA. Management of skin abscesses in the era of methicillin-resistant Staphylococcus aureus. N Engl J Med 2014;370(11):1039–1047. DOI: 10.1056/NEJMra1212788.
  34. Singer AJ, Thode HC. Systemic antibiotics after incision and drainage of simple abscesses: a meta-analysis. Emerg Med J EMJ 2014;31(7):576–578. DOI: 10.1136/emermed-2013-202571.
  35. Esposito S, Noviello S, Leone S. Epidemiology and microbiology of skin and soft tissue infections. Curr Opin Infect Dis 2016;29(2):109–115. DOI: 10.1097/QCO.0000000000000239.
  36. Montravers P, Snauwaert A, Welsch C. Current guidelines and recommendations for the management of skin and soft tissue infections. Curr Opin Infect Dis 2016;29(2):131–138. DOI: 10.1097/QCO.0000000000000242.
  37. Fahimi J, Singh A, Frazee BW. The role of adjunctive antibiotics in the treatment of skin and soft tissue abscesses: a systematic review and meta-analysis. CJEM 2015;17(4):420–432. DOI: 10.1017/cem.2014.52.
  38. Yue J, Dong BR, Yang M, et al. Linezolid versus vancomycin for skin and soft tissue infections. Cochrane Database Syst Rev 2016(1):CD008056. DOI: 10.1002/14651858.CD008056.pub3.
  39. Boucher HW, Wilcox M, Talbot GH, et al. Once-weekly dalbavancin versus daily conventional therapy for skin infection. N Engl J Med 2014;370(23):2169–2179. DOI: 10.1056/NEJMoa1310480.
  40. Scott LJ. Dalbavancin: a review in acute bacterial skin and skin structure infections. Drugs 2015;75(11):1281–1291. DOI: 10.1007/s40265-015-0430-x.
  41. Moran GJ, Fang E, Corey GR, et al. Tedizolid for 6 days versus linezolid for 10 days for acute bacterial skin and skin-structure infections (ESTABLISH-2): a randomised, double-blind, phase 3, non-inferiority trial. Lancet Infect Dis 2014;14(8):696–705. DOI: 10.1016/S1473-3099(14)70737-6.
  42. Prokocimer P, De Anda C, Fang E, et al. Tedizolid phosphate vs linezolid for treatment of acute bacterial skin and skin structure infections: the ESTABLISH-1 randomized trial. JAMA 2013;309(6):559–569. DOI: 10.1001/jama.2013.241.
  43. Raff AB, Kroshinsky D. Cellulitis: a review. JAMA 2016;316(3):325–337. DOI: 10.1001/jama.2016.8825.
  44. Williams DJ, Cooper WO, Kaltenbach LA, et al. Comparative effectiveness of antibiotic treatment strategies for pediatric skin and soft-tissue infections. Pediatrics 2011;128(3):e479–e487. DOI: 10.1542/peds.2010-3681.
  45. Dalal A, Eskin-Schwartz M, Mimouni D, et al. Interventions for the prevention of recurrent erysipelas and cellulitis. Cochrane Database Syst Rev 2017;20(6):CD009758. DOI: 10.1002/14651858.CD009758.pub2.
  46. Ferreira A, Bolland MJ, Thomas MG. Meta-analysis of randomised trials comparing a penicillin or cephalosporin with a macrolide or lincosamide in the treatment of cellulitis or erysipelas. Infection 2016;44(5):607–615. DOI: 10.1007/s15010-016-0895-x.
  47. Kilburn SA, Featherstone P, Higgins B, et al. Interventions for cellulitis and erysipelas. Cochrane Database Syst Rev 2010(6):CD004299. DOI: 10.1002/14651858.CD004299.pub2.
  48. Montravers P, Bassetti M, Dupont H, et al. Efficacy of tigecycline for the treatment of complicated skin and soft-tissue infections in real-life clinical practice from five European observational studies. J Antimicrob Chemother 2013;68(Suppl 2):ii15–ii24. DOI: 10.1093/jac/dkt141.
  49. Chen LL, Fasolka B, Treacy C. Necrotizing fasciitis: a comprehensive review. Nursing (Lond) 2020;50(9):34–40. DOI: 10.1097/01.NURSE.0000694752.85118.62.
  50. Stevens DL, Bryant AE, Goldstein EJ. Necrotizing soft tissue infections. Infect Dis Clin North Am 2021;35(1):135–155. DOI: 10.1016/j.idc.2020.10.004.
  51. Bechar J, Sepehripour S, Hardwicke J, et al. Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature. Ann R Coll Surg Engl 2017;99(5):341–346. DOI: 10.1308/rcsann.2017.0053.
  52. Nawijn F, Smeeing DPJ, Houwert RM, et al. Time is of the essence when treating necrotizing soft tissue infections: a systematic review and meta-analysis. World J Emerg Surg WJES 2020;15(1):4. DOI: 10.1186/s13017-019-0286-6.
  53. Burnham JP, Kollef MH. Treatment of severe skin and soft tissue infections: a review. Curr Opin Infect Dis 2018;31(2):113–119. DOI: 10.1097/QCO.0000000000000431.
  54. Bonne SL, Kadri SS. Evaluation and management of necrotizing soft tissue infections. Infect Dis Clin North Am 2017;31(3):497–511. DOI: 10.1016/j.idc.2017.05.011.
  55. Gadepalli R, Dhawan B, Kapil A, et al. Clinical and molecular characteristics of nosocomial meticillin-resistant Staphylococcus aureus skin and soft tissue isolates from three Indian hospitals. J Hosp Infect 2009;73(3):253–263. DOI: 10.1016/j.jhin.2009.07.021.
  56. Perumal N, Dass BS, Mani S, et al. Prevalence of bi-component pore-forming toxin genotypes of Staphylococcus aureus causing skin and soft tissue infections. Indian J Med Microbiol 2017;35(1):146–147. DOI: 10.4103/ijmm.IJMM_16_424.
  57. Phakade RS, Nataraj G, Kuyare SS, et al. Is methicillin-resistant Staphylococcus aureus involved in community acquired skin and soft tissue infections? Experience from a tertiary care centre in Mumbai. J Postgrad Med 2012;58(1):3–7. DOI: 10.4103/0022-3859.93245.
  58. Zwemer E, Stephens JR. Things we do for no reason: blood cultures for uncomplicated skin and soft tissue infections in children. J Hosp Med 2018;13(7):496–499. DOI: 10.12788/jhm.2984.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.