Selülit/Abse Tanısı ile Servis Yatışı Olan Çocukların Değerlendirilmesi

Yıl 2025, Cilt: 14 Sayı: 1, 186 - 195, 23.03.2025

Berker Okay , Ahsen Güler , Nazife Mengi , Emin Arvas , Ozan Hayrazan , Kamil Şahin , Gülşen Akkoç

Öz

Selülit ve apse, yumuşak doku enfeksiyonları arasında en sık görülen enfeksiyonlardır. Biz bu çalışmamızda, çocuk servislerinde yatarak tedavi alan yumuşak doku enfeksiyonu tanılı hastaları tarayarak, predispozan faktörleri belirlemek ve tedavi seçenekleri ile tedaviye cevabı saptamak istedik. Çocuk Servislerinde yumuşak doku enfeksiyonu tanısı ile yatarak tedavi alan 1 ay-18 yaş aralığındaki hastalar dahil edildi. Başvuru şikayetleri sıralandığında kızarıklık (%75,8), şişlik (%72,6), ağrı (%72,1) ve ateş (%30,0) en sık şikayetlerdi. Hastaların bulguları arasında şişlik/ödem (%85,8) ilk sıradayken, eritem (%75,8) ve ısı artışı (%48,4) diğer sık saptanan bulgulardı. Otuz altı hastanın (%18,9) kan ve abse kültürlerinde bakteriyel etkenler saptandı, on sekizinde stafilokok üremesi görüldü. Ampisilin-sulbaktam (%83,2) ve klindamisin (%66,8) en sık kullanılan tedavilerdi. Hastaların %93,6’sı tedavi değişikliğine gerek kalmadan ilk tedavileri ile düzeldi. Tedavi süresi ortancası 7 (1-26) gün ve tedavi değişikliği sonrası tedavi süresi ortalaması 7,7 ± 4,0 gün olarak görüldü. Yatış süresi 6 (1-16) gün, klinik düzelme süresi 5,5 (2-21) gün, oral tedavi süresi 5,5 ± 1,6 gün olarak saptandı. İlk semptom ile tanı arasında geçen sürenin ortancası ise 3 (1-60) gün idi.
Yumuşak doku enfeksiyonları dar spektrumlu beta-laktam tedavisi ile düşük relaps veya komplikasyon oranları ile tedavi edilebilir. Ülkemizde MRSA sıklığı sebebiyle bu hastalara ek olarak Klindamisin tedavisinin ampirik başlanması düşünülebilir. Antibiyoterapinin en az 7 gün verilmesi komplikasyon ve relapsları önleyebilir.

Anahtar Kelimeler

Abse, Çocuk, Selülit, Tedavi, Yumuşak Doku Enfeksiyonu

Etik Beyan

Kurumsal etik komite, çalışmayı Helsinki Bildirgesi'ne uygun olarak onayladı. Araştırma yapılmadan önce kurumsal etik komiteden (75-2023 karar ve 12.04.2023 tarih nolu) etik izin alınmıştır.

Evaluation of Children Hospitalized With Cellulite/Abscess Diagnosis

Öz

Cellulitis and abscess are the most common soft tissue infections. In this study, we aimed to determine the predisposing factors, treatment options and response to treatment by screening patients with soft tissue infections who were hospitalized in pediatric wards. Patients between the ages of 1 month and 18 years who received inpatient treatment with a diagnosis of soft tissue infection in the Pediatric Services were included. In 36 patients (18.9%), bacterial agents were detected in blood/abscess cultures and staphylococcal growth was observed in half of them. Methicillin-resistant staphylococcus aureus was found in 37.8% and methicillin-sensitive staphylococcus aureus in 8.1%. Ampicillin-sulbactam (83.2%) and clindamycin (66.8%) were the most commonly used treatments. 93.6% of the patients recovered with their first treatment without the need for a change in treatment. The median duration of treatment was 7 (1-26) days, hospitalization was 6 (1-16) days, clinical improvement was 5.5 (2-21) days, and oral treatment was 5.5 ± 1.6 days.
Soft tissue infections can be treated with narrow-spectrum beta-lactam therapy with low relapse or complication rates. Due to the prevalence of MRSA in our country, empirical initiation of clindamycin treatment may be considered in addition to these patients. Antibiotherapy for at least 7 days may prevent complications and relapses.

Anahtar Kelimeler

Abscess, Cellulitis, Child, Soft Tissue Infection, Treatment

Kaynakça

• 1. Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.2014;59(2):e10–e52. https://doi.org/10.1093/cid/ciu444
• 2. Raff AB, Kroshinsky D. Cellulitis: A Review. JAMA.2016;316(3):325–337. https://doi.org/10.1001/jama.2016.8825
• 3. Weng QY, Raff AB, Cohen JM, Gunasekera N, Okhovat JP, Vedak P, et al. Costs and Consequences Associated With Misdiagnosed Lower Extremity Cellulitis. JAMA dermatology.2017;153(2):141–146. https://doi.org/10.1001/jamadermatol.2016.3816
• 4. Carratalà J, Rosón B, Fernández-Sabé N, Shaw E, del Rio O, Rivera A, et al. Factors associated with complications and mortality in adult patients hospitalized for infectious cellulitis. European journal of clinical microbiology & infectious diseases, official publication of the European Society of Clinical Microbiology. 2003;22(3):151–157. https://doi.org/10.1007/s10096-003-0902-x
• 5. Beltran J. MR imaging of soft-tissue infection. Magn Reson Imaging Clin N Am 1995;3:743.
• 6. Dryden MS. Complicated skin and soft tissue infection. The Journal of antimicrobial chemotherapy. 2010;65 Suppl 3, iii35–iii44. https://doi.org/10.1093/jac/dkq302
• 7. Kilburn SA, Featherstone P, Higgins, B, Brindle R. Interventions for cellulitis and erysipelas. The Cochrane database of systematic reviews. 2010;6, CD004299. https://doi.org/10.1002/14651858.CD004299.pub2
• 8. Orkin SH, Nathan DG, Ginsburg D. Nathan and Oski’s Hematology of Infancy and Childhood, 8th Edition, Saunders, Philadelphia. 2015; s.352.
• 9. Yueh CM, Chi H, Chiu NC, Huang FY, Tsung-Ning Huang D, Chang L, et al. Etiology, clinical features, management, and outcomes of skin and soft tissue infections in hospitalized children: A 10-year review. Journal of microbiology, immunology, and infection. 2022;55(4):728–739. https://doi.org/10.1016/j.jmii.2022.01.007
• 10. McNamara DR, Tleyjeh IM, Berbari EF, Lahr BD, Martinez J, Mirzoyev SA, et al. A predictive model of recurrent lower extremity cellulitis in a population-based cohort. Archives of internal medicine.2007;167(7):709–715. https://doi.org/10.1001/archinte.167.7.709
• 11. Quirke M, Ayoub F, McCabe A, Boland F, Smith B, O'Sullivan R, et al. Risk factors for nonpurulent leg cellulitis: a systematic review and meta-analysis. The British journal of dermatology. 2017;177(2):382–394. https://doi.org/10.1111/bjd.15186.
• 12. Siljander T, Karppelin M, Vähäkuopus S, Syrjänen J, Toropainen M, Kere J, et al. Acute bacterial, nonnecrotizing cellulitis in Finland: microbiological findings. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2008;46(6): 855–861. https://doi.org/10.1086/527388
• 13. Bruun T, Oppegaard O, Kittang BR, Mylvaganam, H, Langeland, N. and Skrede, S. Etiology of Cellulitis and Clinical Prediction of Streptococcal Disease: A Prospective Study. Open forum infectious diseases. 2015;3(1):ofv181. https://doi.org/10.1093/ofid/ofv181
• 14. Perl B, Gottehrer NP, Raveh D, Schlesinger Y, Rudensky B, Yinnon AM. Cost-effectiveness of blood cultures for adult patients with cellulitis. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 1999;29(6): 1483–1488. https://doi.org/10.1086/313525
• 15. Gunderson CG, Martinello, RA. A systematic review of bacteremias in cellulitis and erysipelas. The Journal of infection. 2012;64(2):148–155. https://doi.org/10.1016/j.jinf.2011.11.004
• 16. Yakut N, Ergenç Z, Bayraktar S, Akbolat İ, Sayın E, İlki A, et al. Antimicrobial Susceptibility Results and Characterization of Skin and Soft Tissue Infections Caused by Staphylococcus aureus in Children. Flora.2024;29(1):85-95. https://doi.org/10.5578/flora.202401868
• 17. Howard-Jones AR, Al Abdali K, Britton PN. Acute bacterial lymphadenitis in children: a retrospective, cross-sectional study. European journal of pediatrics.2023;182(5):2325–2333. https://doi.org/10.1007/s00431-023-04861-0
• 18. Demongeot N, Akkari M, Blanchet C, Godreuil S, Prodhomme O, Leboucq N, et al. Pediatric deep neck infections: Clinical description and analysis of therapeutic management. Archives de pediatrie: organe officiel de la Societe francaise de pediatrie.2022;29(2):128–132. https://doi.org/10.1016/j.arcped.2021.11.011
• 19. Gokay N, Yeşil E, Dikme G, Kuyucu N. 2023 Yılı pediatrik olgularda deri ve yumuşak doku enfeksiyonlarının değerlendirilmesi. Mersin Üniversitesi Sağlık Bilimleri Dergisi. 2024;17 (özel sayı-1):138-145.
• 20. Neff L, Newland JG, Sykes KJ, Selvarangan R, Wei JL. Microbiology and antimicrobial treatment of pediatric cervical lymphadenitis requiring surgical intervention. International journal of pediatric otorhinolaryngology.2013;77(5):817–820. https://doi.org/10.1016/j.ijporl.2013.02.018
• 21. Principi N, Argentiero A, Neglia C, Gramegna A, Esposito S. New Antibiotics for the Treatment of Acute Bacterial Skin and Soft Tissue Infections in Pediatrics. Pharmaceuticals (Basel, Switzerland). 2020; 13(11):333. https://doi.org/10.3390/ph13110333
• 22. Bishop EJ, Grabsch EA, Ballard SA, Mayall B, Xie S, Martin R, Grayson, ML. Concurrent analysis of nose and groin swab specimens by the IDI-MRSA PCR assay is comparable to analysis by individual-specimen PCR and routine culture assays for detection of colonization by methicillin-resistant Staphylococcus aureus. Journal of clinical microbiology. 2006;44(8):2904–2908. https://doi.org/10.1128/JCM.02211-05
• 23. Baek MY, Park KH, We JH, Park SE. Needle aspiration as therapeutic management for suppurative cervical lymphadenitis in children. Korean journal of pediatrics.2010;53(8):801–804. https://doi.org/10.3345/kjp.2010.53.8.801
• 24. Healy CM, Baker CJ. Soft Tissue Infection. In: Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 8th ed, Elsevier, Philadelphia. 2018;s.124.
• 25. Cooper BJ, Mitchell ML, Melamed S, Liegl M, Pan AY, Burek AG. Improving Antibiotic Use in Pediatric Preseptal Cellulitis Using a Clinical Practice Guideline. Hospital pediatrics. 2024;14(10):791–798. https://doi.org/10.1542/hpeds.2023-007581
• 26. Stevens DL, Gibbons AE, Bergstrom R, Winn V. The Eagle effect revisited: efficacy of clindamycin, erythromycin, and penicillin in the treatment of streptococcal myositis. The Journal of infectious diseases. 1988;158(1):23–28. https://doi.org/10.1093/infdis/158.1.23
• 27. Stoehr GP, Yu VL, Johnson JT, Antal EJ, Townsend RJ, Wagner, R. Clindamycin pharmacokinetics and tissue penetration after head and neck surgery. Clinical pharmacy. 1988; 7(11):820–824.
• 28. White BP, Siegrist E. A. Increasing clindamycin resistance in group A streptococcus. The Lancet. Infectious diseases. 2021;21(9):1208–1209. https://doi.org/10.1016/S1473-3099(21)00456-4
• 29. Miller LG, Daum RS, Creech CB, Young D, Downing MD, Eells SJ, et al. Clindamycin versus trimethoprim-sulfamethoxazole for uncomplicated skin infections. The New England journal of medicine. 2015;372(12):1093–1103. https://doi.org/10.1056/NEJMoa1403789
• 30. Williams DJ, Cooper WO, Kaltenbach LA, Dudley JA, Kirschke DL, Jones TF, et al. Comparative effectiveness of antibiotic treatment strategies for pediatric skin and soft-tissue infections. Pediatrics. 2011;128(3):e479–e487. https://doi.org/10.1542/peds.2010-3681.
• 31. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet (London, England). 2022;399(10325):629–655. https://doi.org/10.1016/S0140-6736(21)02724-0
• 32. Galli L, Venturini E, Bassi A, Gattinara GC, Chiappini E, Defilippi C, et al Common Community-acquired Bacterial Skin and Soft-tissue Infections in Children: an Intersociety Consensus on Impetigo, Abscess, and Cellulitis Treatment. Clinical therapeutics. 2019;41(3):532–551.e17. https://doi.org/10.1016/j.clinthera.2019.01.010
• 33. McPherson Z, Thosar D, Donnelly A, Shaw N, Starte J, Jones M, et al. Evaluation of moderate periorbital cellulitis and home-based therapy in children (EPOCH study, Part 2): A prospective single centre cohort study. Clinical & experimental ophthalmology. 2024. 10.1111/ceo.14455. https://doi.org/10.1111/ceo.14455
• 34. Ibrahim LF, Hopper SM, Babl FE, Bryant PA. Who Can Have Parenteral Antibiotics at Home?: A Prospective Observational Study in Children with Moderate/Severe Cellulitis. The Pediatric infectious disease journal. 2016;35(3):269–274. https://doi.org/10.1097/INF.0000000000000992
• 35. McMullan BJ, Andresen D, Blyth CC, Avent ML, Bowen AC, Britton PN, et al. Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: systematic review and guidelines. The Lancet. Infectious diseases. 2016;16(8):e139–e152. https://doi.org/10.1016/S1473-3099(16)30024-X
• 36. Mascitti KB, Gerber JS, Zaoutis TE, Barton TD, Lautenbach E. Preferred treatment and prevention strategies for recurrent community-associated methicillin-resistant Staphylococcus aureus skin and soft-tissue infections: a survey of adult and pediatric providers. American journal of infection control. 2010;38(4):324–328. https://doi.org/10.1016/j.ajic.2009.11.007.
• 37. Babar TF, Zaman M, Khan MN, Khan MD. Risk factors of preseptal and orbital cellulitis. Journal of the College of Physicians and Surgeons--Pakistan: JCPSP. 2009;19(1):39–42.
• 38. Smith TF, O'Day D, Wright PF. Clinical implications of preseptal (periorbital) cellulitis in childhood. Pediatrics. 1978;62(6):1006–1009.
• 39. Nghiem AZ, Sanz-Magallon Duque de Estrada B, Farwana R, Osborne SF. Pediatric preseptal and orbital cellulitis - a 6 year experience from a London tertiary centre. Orbit (Amsterdam, Netherlands). 2024;43(3):301–306. https://doi.org/10.1080/01676830.2023.2296563
• 40. Şen Tunç E, Ulusoy Yamak AT, Kaya Z, Ghulam Nabi BM. Diş Kaynaklı Yüz Selülitlerinin Bir Grup Türk Çocuk Hastada Retrospektif Olarak Değerlendirilmesi. Turkiye Klinikleri J Dental Sci, 2022;28(2):338-343. https://doi.org/10.5336/dentalsci.2021-85263 41. Kaman A, Teke TA, Öz FN, Bayhan Gİ, Metin Ö, Gayretli Aydın ZG, et al. Diş Kaynaklı Fasiyal Selülit Olgularının Klinik, Laboratuvar Özellikleri ve Tedavi Yönetimi. J Pediatr Inf. 2018;12(2):45-51. https://doi.org/10.5578/ced.67428