1525. Epidemiology, Management, and Outcomes of Skin and Soft-Tissue Infections in Well-Appearing Infants Less Than 60 Days of Age

BACKGROUND: Skin and soft-tissue infections (SSTIs) in children are increasingly common. The IDSA has published guidelines for SSTI treatment in children, adolescents, and adults but data in infants less than 2 months is sparse despite their higher risk of concomitant serious bacterial infection (SBI). Clinical work-up and management of these patients varies widely with little evidence to guide providers. METHODS: We retrospectively identified 536 patients, from 2007 to 2017, seen at our EDs or hospital-associated clinic and diagnosed with SSTI by ICD9/10 code. We excluded those with ill-appearance, prematurity, known immunodeficiency, skin disorder, previous SSTI, or previous procedure at infection site. Remaining patient’s medical records were reviewed to confirm a SSTI. The total included study population was 182 (Figure 1). Data collected included demographics, type/location of infection, laboratory/imaging studies obtained, procedures performed, disposition, treatment, and treatment failure. RESULTS: Demographics are reported in Table 1. Mean age was 24.2 days (range 2–57 days). Of 182 patients, 13% had fever. 34% had a superficial infection (impetigo or pustulosis), 24% had cellulitis/scalded skin, 35% had an abscess/paronychia, and 7% had periorbital cellulitis. The most common SSTI locations were perineal/genital (30%) and head/scalp/face (23%). 63% of infants had a blood culture obtained and 4/114 grew a pathogenic bacteria. 52% had a wound culture and 72/95 grew a pathogenic bacteria. No infants had bacterial meningitis or a UTI (Table 2). 25% underwent incision/drainage and 93% received any antibiotic. The most commonly prescribed antibiotics were clindamycin and mupirocin. Of 80 non-admitted infants, 21% had an unscheduled return visit within 2 weeks (Table 3): 9% for treatment failure, 6% unrelated to SSTI, and 1% for missed SBI (1 patient with GAS bacteremia). CONCLUSION: Most well-appearing infants with SSTI were afebrile. The majority of studied infants had blood cultures obtained but rates of clinically significant bacteremia were low. Management varied considerably and antibiotics were commonly administered. However, overall rates of SBI were low and there was only 1 case of missed SBI. Extensive evaluation of well-appearing infants with SSTI may be unnecessary. [Image: see text] [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.