Medical Student University of Massachusetts Medical School MILTON, Massachusetts, United States
Background: Obtaining blood cultures is not a common part of skin abscess evaluation among immunocompetent children. Done at the discretion of the treating provider, it is usually reserved, when there is a concern for bacterial spread/shedding among children that are febrile, have a large cellulitis component or other concerning features. This practice is often followed by administration of intravenous (IV) antibiotics and possible admission. Objective: We sought to assess the rate of bacteremia among children with skin abscesses who had a blood culture drawn. Design/Methods: A cross-sectional chart review was performed at a tertiary care emergency department (ED) between 2017 and 2023. We reviewed the notes of all patients with the following inclusion criteria: (1) ICD10 codes for skin abscess, (2) had an I&D performed and (3) had a blood culture obtained. We excluded the following populations of patients: immunocompromised, surgical wound infections, deep tissue or bone involvement, complex medical history (peritoneal dialysis, abscess near indwelling catheter), and pretreatment with systemic antibiotics. Our primary outcome was a positive blood culture for a pathogen. Results: We identified 91 patient meeting the inclusion criteria. 41/91 (45%) were female and the median age was 2 years (IQR 1.1-13). Among the cohort, 62 (68%) were febrile. Among the non-febrile patients, the leading rationale for obtaining blood culture and administering IV antibiotics were an abscess overlying a joint and emesis. Among admitted patients, median length of stay was 2 days (IQR 2-3). Eighty-five patients (93.5%) were treated with IV antibiotics; the leading medication was clindamycin. Fifteen patients received more than one IV antibiotic in combination, and 13 patients were treated with vancomycin either as a single drug or in combination. None of the blood culture grew a pathogen (0%, 95% Confidence Interval 0-5%). Our sample had no blood culture contaminants.
Conclusion(s): The rate of bacteremia among healthy patients with either fever or slightly complicated skin abscess appears low in this preliminary single center dataset. While these results do not rule out bacterial shedding, they do not support this concern. These preliminary data will be part of a larger study that will allow a narrower confidence interval and stratification by blood culture drawing indications.
