Get access

Empiric Antibiotics and Outcomes of Children Hospitalized with Eczema Herpeticum

Authors

  • Paul L. Aronson M.D.,

    1. Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
    2. Department of Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
    Search for more papers by this author
  • Albert C. Yan M.D.,

    1. Department of Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
    2. Section of Dermatology, Divisions of General Pediatrics and Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
    3. General Pediatrics and Infectious Diseases and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
    4. Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
    Search for more papers by this author
  • Zeinab Mohamad M.S.,

    1. Infectious Diseases, and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
    2. Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
    Search for more papers by this author
  • Manoj K. Mittal M.D.,

    1. Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
    2. Department of Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
    Search for more papers by this author
  • Samir S. Shah M.D., M.S.C.E.

    1. Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
    2. Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
    3. Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
    Search for more papers by this author

Address correspondence to Paul L. Aronson, M.D., Division of Emergency Medicine, 3501 Civic Center Boulevard, CTRB 9th Floor, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, or e-mail: aronsonp@email.chop.edu.

Abstract

Abstract:  Although patients with eczema herpeticum often receive antibiotics for presumed bacterial coinfection, the effect of empiric antibiotic therapy is unknown. Our objective therefore was to determine the association between empiric antibiotics and outcomes in children hospitalized with eczema herpeticum. We conducted a multicenter retrospective cohort study of 1,150 children ages 2 months to 17 years admitted with eczema herpeticum between January 1, 2001, and March 31, 2010, to 42 tertiary care children’s hospitals in the Pediatric Health Information System. All patients received antibiotics during the hospitalization. Multivariable linear regression models determined the association between empiric antibiotic therapy and the main outcome measure: hospital length of stay (LOS). There were no deaths during the study period. Receipt of empiric antibiotics was not associated with a change in the LOS on unadjusted or multivariable analysis. The class of empiric antibiotic was not associated with the LOS except for receipt of vancomycin, which was associated with a longer LOS (21% adjusted longer LOS, 95% confidence interval (CI) = 8–35%; p = 0.001). When restricted to patients with a bloodstream infection, receipt of empiric antibiotics was associated with a 51% adjusted shorter LOS (95% CI = −24 to −68%; p = 0.002). In children hospitalized with eczema herpeticum, empiric antibiotic therapy was not associated with a shorter LOS overall, but was associated with a shorter LOS in patients with a bloodstream infection. These findings highlight the importance of early recognition of systemic bacterial illness in children with eczema herpeticum. Empiric antibiotics did not affect mortality, which is low.

Ancillary