Emergency Department Diagnosis and Management of Skin and Soft-Tissue Infections in Children (Infectious Disease CME and Pharmacology CME)

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Publication Date: April 2025 (Volume 22, Number 4)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 04/01/2028.

Specialty CME Credits:Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME credits and 1 Pharmacology CME credit, subject to your state and institutional approval.

Authors

Peer Reviewers

Abstract

Children with skin and soft-tissue infections (SSTIs) commonly present to the emergency department, and while most of these infections are mild, some can be severe, with high morbidity and mortality. Emergency clinicians must be able to recognize frequently encountered SSTIs and be prepared to treat them appropriately. This issue reviews the various etiologies and patient presentations of common SSTIs, including purulent, nonpurulent, and necrotizing infections. Findings on the history and physical examination that can differentiate SSTIs from mimics are discussed, and evidence-based recommendations are provided for management.

Case Presentations

A 5-year-old boy presents with his mother, who has concerns about redness and pain in his arm…

• He is accompanied by his mother, who recalls that he had a barely noticeable scratch on the arm after playing at the playground a few days ago.
• His mother says redness developed and extended gradually over the next 3 days.
• On examination, he has a 4-cm area of erythema that is mildly tender to palpation. His history and vital signs confirm no fever or other concerning systemic signs.
• Are laboratory studies and imaging indicated? Should you prescribe antibiotics?

A family brings their 16-month-old girl to the ED for redness and swelling of the right buttock...

• Her parents say this started as a smaller area of redness and swelling that has grown larger over the last 4 days. They have not seen any drainage in the area but have noticed it is rather painful. They tell you the girl has not had any fevers, and she is active but fussy.
• The girl’s vital signs are normal. On examination, you note a 7-cm area of erythema and induration, but it is unclear whether it is fluctuant. There is no obvious drainage or pustule. The girl cries during the examination, and it appears to be related to tenderness.
• How should you further evaluate this patient? What imaging should you consider?

EMS brings in an ill-appearing 10-year-old boy with a leg wound, fever, and tachycardia…

• The boy’s mother tells you he fell from his bike 2 days ago and sustained an abrasion, but otherwise, he seemed fine at the time. The family tells you they were alarmed that within 24 hours after the fall, the boy developed significant redness, swelling, and pain. They planned to take him to their pediatrician but became worried when he did not appear well and became significantly less active, which prompted the call to EMS.
• The boy’s vital signs are: temperature, 39.0°C; heart rate, 140 beats/min; blood pressure, 88/40 mm Hg; respiratory rate, 18 breaths/min; and oxygen saturation, 98% on room air.
• What are the most important and immediate next steps? Who should you consider consulting?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.