OBJECTIVES: Describe the clinical presentation, prevalence, and outcomes of concurrent serious bacterial infection (SBI) among infants with mastitis. METHODS: Within the Pediatric Emergency Medicine Collaborative Research Committee, 28 sites reviewed records of infants aged #90 days with mastitis who were seen in the emergency department between January 1, 2008, and December 31, 2017. Demographic, clinical, laboratory, treatment, and outcome data were summarized. RESULTS: Among 657 infants (median age 21 days), 641 (98%) were well appearing, 138 (21%) had history of fever at home or in the emergency department, and 63 (10%) had reported fussiness or poor feeding. Blood, urine, and cerebrospinal fluid cultures were collected in 581 (88%), 274 (42%), and 216 (33%) infants, respectively. Pathogens grew in 0.3% (95% confidence interval [CI] 0.04–1.2) of blood, 1.1% (95% CI 0.2–3.2) of urine, and 0.4% (95% CI 0.01–2.5) of cerebrospinal fluid cultures. Cultures from the site of infection were obtained in 335 (51%) infants, with 77% (95% CI 72–81) growing a pathogen, most commonly methicillin-resistant Staphylococcus aureus (54%), followed by methicillin-susceptible S aureus (29%), and unspecified S aureus (8%). A total of 591 (90%) infants were admitted to the hospital, with 22 (3.7%) admitted to an ICU. Overall, 10 (1.5% [95% CI 0.7–2.8]) had sepsis or shock, and 2 (0.3% [95% CI 0.04–1.1]) had severe cellulitis or necrotizing soft tissue infection. None received vasopressors or endotracheal intubation. There were no deaths. CONCLUSIONS: In this multicenter cohort, mild localized disease was typical of neonatal mastitis. SBI and adverse outcomes were rare. Evaluation for SBI is likely unnecessary in most afebrile, well-appearing infants with mastitis.
Bibliographical noteFunding Information:
Address correspondence to Ron L. Kaplan, MD, Department of Pediatric Emergency Medicine, School of Medicine, University of Washington and Seattle Children’s Hospital, 4800 Sand Point Way NE, MB.7.520, Seattle, WA 98105. E-mail: email@example.com PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2021 by the American Academy of Pediatrics FINANCIAL DISLCOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. FUNDING: Dr Stephen Freedman is supported by the Alberta Children’s Hospital Foundation Professorship in Child Health and Wellness. POTENTIAL CONFLICTS OF INTEREST: Dr Andrea Cruz is an associate editor of Pediatrics; the other authors have indicated they have no potential conflicts of interest to disclose.
Copyright © 2021 by the American Academy of Pediatrics
PubMed: MeSH publication types
- Journal Article
- Multicenter Study
- Research Support, Non-U.S. Gov't