Pediatric emergency medicine trisk 594

e-TABLE 94.11
PREVALENCE OF URINARY TRACT INFECTION IN FEBRILE
CHILDREN YOUNGER THAN 24 MONTHS
Age (mo)

Prevalence (%)

Females:
Prevalence (%)

Males:
Prevalence %

0–1
>1–3
>3–6
>6–9
>9–12
>12–18

6.9
5.5
3.6
2.1
1.4
0.8

5.1
5.9
5.1
3.7

2.3
1.4

8.5
5.3
2.5
0.8
0.7
0.4

>18–24

0.8

1.4

0.3

Modified from Bachur R, Harper M. Reliability of the urinalysis for predicting urinary tract infections in
young febrile children. Arch Pediatr Adolesc Med 2001;155:60–65.


e-TABLE 94.12
COMMON ETIOLOGIES FOR CELLULITIS


Scenario

Etiologies

Facial cellulitis (buccal, S. aureus, GAS,
periorbital)
pneumococcus
Erysipelas
Predominantly GAS

Odontogenic

Usually polymicrobial:
viridans group
streptococci,
Prevotella,
Fusobacterium

Cellulitis in patients
with lymphedema

GAS most common, S.
aureus

Trunk or extremities
Perineal

Perianal cellulitis

S. aureus, GAS
Often polymicrobial: S.
aureus, GAS, enteric
GNRs, Bacteroides
and other anaerobes

GAS

Cellulitis after water
exposure

S. aureus, GAS, Vibrio
vulnificus,

Comments
Hib cellulitis rare in
vaccinated children
Raised, beefy red, very
well-demarcated
borders; most common
on the legs; if see
involvement of the ear
(Milian ear sign), likely
erysipelas
Abscess drainage
essential; one
complication can be
Ludwig angina, a
rapidly progressive
cellulitis of the floor of
the mouth that can
result in airway
obstruction
Some patients may benefit
from oral PCN VK
prophylaxis if have

recurrent episodes
Over 70% are S. aureus
One risk factor in
adolescents is shaving
the genital area
Rapid strep swabs, while
not licensed outside the
nasopharynx, can help
guide initial therapy
Vibrio causes rapidly
progressive cellulitis
with bullae formation


Aeromonas, other
water pathogens

and ecchymoses after
contact with brackish or
coastal water; it has also
been associated with
puncture wounds from
stingrays and fish
Cellulitis after animal
Pasteurella multocida, S. More common after cat
bite
aureus, GAS;
bites, which result in
Capnocytophaga
deep punctures that are

canimorsus
more difficult to irrigate
thoroughly; symptoms
begin within 24 hrs. Use
of amoxicillinclavulanate after animal
bites (or clindamycin +
trimethoprimsulfamethoxazole for
PCN-allergic patients)
is targeted to decrease
the risk of P. multocida
infection. Can also see
gram-positive infections
from inoculation of the
child’s skin flora deep
into a wound. C.
canimorsus most
common in
immunocompromised
hosts after dog bites or
dogs licking open
wounds
Cellulitis after clenched Eikenella corrodens,
Aerobic and anaerobic
fist injury
anaerobes; often
cultures should be sent;
polymicrobial from
in some case series,
oral flora
most pathogens are

PCN-susceptible
Plantar, following
S. aureus, GAS,
In some series,