University of Wisconsin–Madison Medical College of Wisconsin

Skin and Soft Tissue Infections in Young Infants

Sheila Swartz, MD, MPH; Leah Cotter, MD; Anika Nelson, MD; Jian Zhang, PhD; Ke Yan, PhD; Michelle L Pickett, MD, MS

WMJ. 2023;122(2):105-109.

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Introduction: The management of young infants with skin and soft tissue infection is not well-defined.

Methods: We performed a survey study of pediatric hospital medicine, emergency medicine, urgent care, and primary care physicians to assess the management of young infants with skin and soft tissue infection. The survey included 4 unique scenarios of a well-appearing infant with uncomplicated cellulitis of the calf with the combination of age ≤ 28 days vs 29–60 days and the presence vs absence of fever.

Results: Of 229 surveys distributed, 91 were completed (40%). Hospital admission was chosen more often for younger infants (≤ 28 days) versus older infants regardless of fever status (45% vs 10% afebrile, 97% vs 38% febrile, both P < 0.001). Younger infants were more likely to get blood, urine, and cerebrospinal fluid studies (P < 0.01). Clindamycin was chosen in 23% of admitted younger infants compared to 41% of older infants (P < 0.05).

Conclusions: Frontline pediatricians appear relatively comfortable with outpatient management of cellulitis in young infants and rarely pursued meningitis evaluation in any afebrile infants or older febrile infants.

Author Affiliations: Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin (Swartz, Cotter, Nelson, Zhang, Yan, Pickett).
Corresponding Author: Sheila Swartz, MD, Medical College of Wisconsin, PO Box 1997, Milwaukee, WI 53201-1997; phone 419.377.8868; email; ORCID ID 0000-0002-3529-2002
Financial Disclosure: None declared.
Funding/Support: None declared.
Acknowledgements: The authors wish to acknowledge Viday Heffner, MD, for support in study design and Kelsey Porada for assistance in design of the data collection instrument and preparation of the manuscript.
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