title: Scratching the surface: a review of skin and soft tissue infections in children.
abstract: OBJECTIVE
  We present data from recently conducted research on the diagnosis and management of skin and soft tissue infections (SSTIs) in children.
  
  
  RESULTS
  Current research in the area of SSTIs (cellulitis and abscess) has focused on the use of ultrasound, risk factors associated with bacteremia, antibiotic choice, and incision and drainage (I&D) practices. When clinical examination is equivocal at distinguishing abscess from cellulitis, ultrasound can aid in the diagnosis and alter management. Bacteremia is rare in immunocompetent children with uncomplicated SSTIs; blood cultures may be reserved for complicated cases and for those who are systemically ill. Despite the increased prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), I&D without antibiotics remains the first-line therapy for abscess. Antibiotics for uncomplicated cellulitis should target β-hemolytic streptococci and methicillin-susceptible S. aureus (MSSA). There are significant variations in pain and sedation practices for I&D, with substantive evidence for the use of topical anesthetics. Wound packing after I&D may not confer significant benefit.
  
  
  CONCLUSIONS
  Evidence to aid in the diagnosis and management of SSTIs in children has emerged in recent years; however, larger prospective pediatric studies are needed.
authors.affiliation: Department of Pediatrics, Division of Emergency Medicine, Columbia University Medical Center, New York, USA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Fenster
authors.forename: Madeline H
authors.initials: MH
authors.lastname: Renny
authors.forename: Carrie
authors.initials: C
authors.lastname: Ng
authors.forename: Cindy G
authors.initials: CG
authors.lastname: Roskind
mesh_terms: D000038:Abscess / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia; D002481:Cellulitis / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods; D019317:Evidence-Based Medicine; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D015995:Prevalence; D011446:Prospective Studies; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D013207:Staphylococcal Skin Infections / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents