This study retrospectively examined pediatric case under the age of 18 who were hospitalized and treated in the pediatric infectious diseases clinic for SSTIs between 2023–2024. Our study, demographic, clinical, and laboratory data of SSTI cases, isolated microorganisms, antibiotics used, and hospitalization durations were evaluated. SSTIs are one of the significant reasons for pediatric patients' hospitalization and initiation of parenteral antibiotics. If not diagnosed and treated promptly, complications may develop. A three-year retrospective study in the United States analyzed 446 pediatric patients under 18 years old hospitalized for SSTIs. The study found that the average hospital stay was 11 days, with males comprising 54% of the cases and a median patient age of 10 years (4–16)
5. In our study, the hospital stay duration was 11 days (range: 4–40), and males accounted for 51.4% of the cases, aligning with findings in the literature.
Chand et al. 6 in their study investigating the clinical characteristics and treatment outcomes of cellulitis cases without abscesses in hospitalized pediatric patients, confirmed that cellulitis was the most common SSTI. Similarly, in our study, cellulitis emerged as the most prevalent type of infection. In a one-year retrospective study conducted by Elise Salleo et al. 5 in Western Australia, the extremities were identified as the most commonly affected body region in pediatric patients admitted to a tertiary hospital. Likewise, in our study, 49 cases (34%) of cellulitis and 40 cases (27.8%) of abscesses were located in the lower extremities. The same study reported that among 639 culture-positive isolates, 363 (56.8%) were community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) 7. In our study, among 65 (45.1%) culture-positive isolates, the most frequently isolated pathogen among gram-positive agents was community-acquired methicillin-sensitive Staphylococcus aureus (CA-MSSA) in 40 cases (27.8%). A retrospective study conducted at Istanbul University Cerrahpaşa Faculty of Medicine reported that among 35 pediatric patients hospitalized for perianal abscesses between 2009 and 2017, 54.3% underwent surgical drainage. In our study, 58 patients (40.3%) underwent surgical drainage, yielding results consistent with the literature 8. In a retrospective evaluation of 20 patients hospitalized with preseptal and orbital cellulitis at Ankara University Faculty of Medicine over eight years, no mortality was reported. Additionally, a study conducted at Ankara Sami Ulus Training and Research Hospital retrospectively analyzed 242 pediatric patients under the age of 15 diagnosed with SSTIs over four years, reporting no infection-related mortality 9,10. In our study, no sequelae, functional impairment, or deformities associated with soft tissue infections were observed at the end of treatment, and no mortality was recorded. The treatment of suppurative complications such as abscesses requires incision and drainage before initiating parenteral antibiotics 11,12. Abscesses are commonly reported to be caused by Staphylococcus aureus. Until recently, incision and drainage alone were considered the preferred method for abscess treatment without the need for antibiotics 13. In our study, S. aureus growth was detected in abscess cases, consistent with the literature. Antibiotic selection is generally based on clinical status. Considering the rising prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the community, empirical antibiotic treatment should include coverage for this pathogen 14.
Recent studies have emphasized the importance of incision and drainage, demonstrating that adjunctive treatment with clindamycin or trimethoprim-sulfamethoxazole for up to seven days post-procedure offers therapeutic benefits 15. In our study, clindamycin was also added to the antibiotic regimens of treated patients. Preserving skin integrity, avoiding insect bites, and maintaining regular hand hygiene are effective measures for preventing skin infections 16. Preventing cellulitis will reduce the burden of hospitalization for children and their families. Current national guidelines for cellulitis prevention strategies include the use of insect repellents, the application of antiseptics to minor injuries, and the potential implementation of a Group A Streptococcus (GAS) vaccine if available in the next decade 17. In Canada, the majority of emergency department visits have been reported to be due to insect bites (21.6%) and trauma (20.3%), resulting in extremity cellulitis in most cases (69.5%) 18. In our study, similar to the literature, extremity cellulitis was more frequently observed in both groups. Pathogen identification in cellulitis remains challenging 19. This study confirms that blood cultures in immunocompetent children do not have significant clinical value in the diagnosis of cellulitis. Our study found that blood culture positivity was not clinically significant in diagnosis, whereas wound cultures were more useful, with positive results obtained in over 80% of tested samples. Comparison of demographic and laboratory values between blood and wound culture-positive cases revealed that blood culture positivity was significantly associated with hospitalization, whereas wound culture positivity correlated with sedimentation levels and hospital stay duration. Methicillin-sensitive Staphylococcus aureus (MSSA) was the most frequently isolated organism, while the role of Streptococcus pyogenes (GAS) may not have been fully evaluated. A serology-based study in adults with cellulitis indicated that 73% of culture-negative cellulitis cases were associated with Streptococcus pyogenes (GAS) 20. The length of hospital stay observed in our study is consistent with findings in the international literature on cellulitis and superficial skin and soft tissue infections (SSTIs) 18,21.
A limitation of this study is its retrospective design. Additionally, the study population is restricted to moderate to severe cellulitis cases, as mild cases are generally treated on an outpatient basis. Based on our findings, future research should evaluate the effectiveness of targeted prevention strategies for high-risk populations. Pediatric skin and soft tissue infections (SSTIs) remain a leading cause of hospitalization among children in our country. Preventing pediatric cellulitis will necessitate a comprehensive approach, incorporating strategies to prevent insect bites, reduce minor trauma, and potentially investigate future vaccination options against Streptococcus pyogenes (GAS).
In conclusion, skin and soft tissue infections (SSTIs) are among the most common infectious causes of hospitalization in pediatric patients. This single-center retrospective study contributes to the limited body of knowledge by providing comprehensive clinical, laboratory, and microbiological data from hospitalized children with SSTIs in a tertiary care setting in Turkey. The findings demonstrate that cellulitis and abscesses are the predominant presentations, with the lower extremities most commonly affected and Staphylococcus aureus (particularly CA-MSSA) being the leading pathogen. Empirical antibiotic therapy, guided by local epidemiology, was effective in the majority of cases, with no observed sequelae or mortality. Our results support the importance of wound cultures over blood cultures for pathogen detection and highlight ESR as a potential marker of disease severity. The study emphasizes the need for region-specific data to optimize empirical treatment strategies and guide infection control policies. Future prospective studies are warranted to evaluate the long-term outcomes and preventive strategies, including hygiene education and potential vaccine development for Streptococcus pyogenes.
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