(835) Skin and Soft Tissue Infections in Critically Ill Children: A Retrospective Cohort Study

Introduction: Skin and soft tissue infections (SSTIs) present a significant healthcare burden in critically ill children. Severe SSTIs, such as necrotising fasciitis, can lead to organ dysfunction and septic shock, resulting in high mortality and long-term complications. There is no data from resource-limited countries on the outcome of such children.

Methods: This retrospective analysis included all SSTI-diagnosed children, aged 1month-12 years, admitted to the PICU of a North Indian quaternary teaching hospital, between 2018 and 2022. Electronic patient records were screened for SSTI using "cellulitis," "necrotizing fasciitis," and "abscess" terms. Pre-designed proforma collected demographics, clinical presentation, SSTI type, intensive care needs, and outcome.

Results: Of the total of 85 children enrolled, 44 were boys. The median age of study subjects was 5 years (IQR: 1.5 months to 12 years). Cellulitis 51 (60%), abscesses 22(26%), bullae 8(9%) and necrotizing fasciitis 3(6%) were the most common SSTIs. Osteomyelitis and septic arthritis were seen in 27(32%) children. At admission, all children had fever while 69(82%) had respiratory distress. Median PRISM was 11. Septic shock needing fluids/vasoactives was seen in 46(55%) patients and deep vein thrombosis (DVT) in 10(12.5%). Thrombocytopenia, lymphopenia and raised CRP were seen in 49(58%), 27(45%), and 100 % respectively.
Methicillin-sensitive and methicillin-resistant Staphylococcus aureus were isolated in 29(35%) and 8(10%) cases respectively. PICU needs included invasive mechanical ventilation in 27 (32%), NIV in 5 (6.25%) and fluids/vasoactives in 46(55%). Antibiotics used were ceftriaxone and cloxacillin combination in 82(96%), and vancomycin in 29(35%) children. Toxic shock syndrome was treated with IV immunoglobulin in 5 (6.5%) children. Surgical debridement and drainage were performed on 34 children (40%). Seven (8.7%) children died. Median duration of mechanical ventilation was 4 days, and PICU stay was 9.5 days (IQR 1-40).

Conclusions: SSTIs are common in PICUs. Among them, cellulitis was the most frequent. Complications included septic shock and DVT. Staphylococcus aureus was the predominant pathogen isolated. Early diagnosis, appropriate antimicrobial treatment, surgical debridement, and supportive care determines the outcome.