552 - Diagnostic Yield of Blood Cultures in Children Undergoing Abscess Incision & Drainage

Publication Number: 2537.552

Jeffrey T. Neal, Boston Children's Hospital, Boston, MA, United States; James Chamberlain, Children's National Health System, Washington, DC, United States; Sharon Smith, University of Connecticut School of Medicine, Hartford, CT, United States; James Rudloff, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Elizabeth M. Waltman, University of Massachusetts Medical School, Milton, MA, United States; MARVIN B. HARPER, Harvard Medical School, NORTH READING, MA, United States; Assaf Landschaft, Boston Children's Hospital, Bergisch Gladbach, Nordrhein-Westfalen, Germany; Eman Ansari, Harvard Medical School, Newton, MA, United States; Amir Kimia, Connecticut Children's Medical Center, Boston, MA, United States

Background: In children undergoing incision and drainage (I&D) of skin abscesses, the decision to obtain blood cultures is at the discretion of the treating clinician and typically reserved for cases suggesting possible bacterial dissemination, such as fever, extensive cellulitis, or systemic symptoms. These patients are often treated with intravenous (IV) antibiotic administration and may require hospital admission.

Objective: We sought to determine the prevalence of bacteremia among otherwise healthy children with skin abscesses and to evaluate its association with subsequent interventions.

Design/Methods: We conducted a multicenter, cross-sectional chart review at four tertiary-care emergency departments (EDs) between 2015 to 2025. Eligible patients included otherwise healthy children with an ICD-10 diagnosis of skin abscess who underwent I&D in the ED and had a blood culture obtained. Exclusion criteria included immunocompromised status, surgical wound infection, deep tissue or osseous involvement, complex medical conditions (e.g., dialysis, indwelling catheter), or prior systemic antibiotic treatment.

The primary outcome was a positive blood culture for a pathogenic organism. The secondary outcome was hospital admission following ED management.

Results: We identified 166 patients meeting inclusion criteria; 71/166 (42.7%) were female, with a median age of 3.4 years (IQR 1.1 – 13.6). Among the cohort, 97/166 (58%) were febrile. No blood cultures grew a pathogenic organism. One contaminant was identified.

122/166 (73.5%) were admitted, with a median hospital length of stay of 2.0 days (IQR 1.8 – 3.0). IV antibiotics were administered to 85 patients (69.7%), most commonly clindamycin. Eighteen patients received combination IV therapy, and 14 patients received vancomycin, either alone or in combination. Other aggressive IV treatments included linezolid and levofloxacin.

Conclusion(s): Bacteremia among otherwise healthy children with skin abscesses undergoing I&D is uncommon. Although transient bacteremia cannot be excluded, these findings suggest that routine blood culture testing in this population has minimal diagnostic yield. Given that I&D provides definitive therapy, often eliminating a dissemination nidus, these results support more judicious use of blood cultures and IV antibiotics to optimize antibiotic stewardship and reduce unnecessary interventions.