title: Management of afebrile neonates with skin and soft tissue infections in the pediatric emergency department.
abstract: OBJECTIVE
  To describe the management of afebrile neonatal skin and soft tissue infections (SSTIs) in the pediatric emergency department (PED).
  
  
  METHODS
  This is a retrospective cohort study of all patients aged 0 to 28 days seen in the PED for SSTIs from 2004 to 2010. The SSTIs were identified from the International Classification of Diseases, Ninth Revision codes of pustulosis, cellulitis, and abscess. Records were reviewed to determine the absence of fever; anatomical location; cultures of blood, urine, and cerebrospinal fluid; antibiotic usage; and return visits. Data were analyzed to compare admitted versus discharged patients with SSTI subtypes.
  
  
  RESULTS
  Of the 136 neonates identified, 104 met inclusion criteria. Afebrile SSTIs included 8 pustulosis, 45 cellulitis, and 51 abscesses. Blood cultures were obtained in 13% of pustulosis, 96% of cellulitis, and 69% of abscesses. No serious bacterial infection was noted. Three blood cultures grew contaminants. Parenteral antibiotics for neonates with pustulosis, cellulitis, and abscesses were given in 13%, 87%, and 59%, respectively. Admission rates for neonates with pustulosis, cellulitis, and abscesses were 13%, 84%, and 55%, respectively. Cases of cellulitis were more likely to have blood cultures drawn (odds ratio [OR], 13.7; 95% confidence interval [CI], 3.03-62.3), receive intravenous antibiotics (OR, 5.87; 95% CI, 2.16-15.0), and be admitted to the hospital (OR, 5.62; 95% CI, 2.16-14.6) as compared with the other SSTI subtypes.
  
  
  CONCLUSIONS
  None of the neonates who had cultures drawn had serious bacterial infection. The SSTI subtype correlated with the extent of evaluation and dispositions. The findings of this study will help with management strategies for afebrile neonates with SSTIs in the PED.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30329, USA. sakhara@emory.edu
authors.forename: Shervin A
authors.initials: SA
authors.lastname: Kharazmi
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Hirsh
authors.forename: Harold K
authors.initials: HK
authors.lastname: Simon
authors.forename: Shabnam
authors.initials: S
authors.lastname: Jain
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001831:Body Temperature; D004333:Drug Administration Routes; D004630:Emergencies; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D012189:Retrospective Studies; D012874:Skin Diseases, Infectious / Q000188:drug therapy*; D018461:Soft Tissue Infections / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents