Luisa Galli1, Elisabetta Venturini2, Andrea Bassi3, Guido Castelli Gattinara4, Elena Chiappini2, Claudio Defilippi5, Andrea Diociaiuti6, Susanna Esposito7, Silvia Garazzino8, Antonietta Giannattasio9, Andrzej Krzysztofiak10, Stefano Latorre11, Andrea Lo Vecchio9, Paola Marchisio12, Carlotta Montagnani2, Giangiacomo Nicolini13, Andrea Novelli14, Gian Maria Rossolini15, Chiara Tersigni2, Alberto Villani10, May El Hachem6, Iria Neri16. 1. Department of Health Sciences, University of Florence, Pediatric Infectious Diseases Division, Anna Meyer Children's University Hospital, Florence, Italy. Electronic address: luisa.galli@unifi.it. 2. Department of Health Sciences, University of Florence, Pediatric Infectious Diseases Division, Anna Meyer Children's University Hospital, Florence, Italy. 3. Department of Health Sciences, University of Florence, Florence, Italy. 4. Vaccination Unit, University Hospital Paediatric Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. 5. Pediatric Radiology, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy. 6. Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. 7. Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, Perugia, Italy. 8. Pediatric Infectious Diseases Unit, Regina Margherita Hospital, University of Turin, Turin, Italy. 9. Section of Pediatrics, Department of Translational Medical Science, University of Naples Federico II, Naples, Italy. 10. Pediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children Hospital, Rome, Italy. 11. Department of Surgery, IRCCS Bambino Gesù Children Hospital, Rome, Italy. 12. Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 13. Pediatric Unit, San Martino Hospital, Belluno, Italy. 14. Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy. 15. Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy. 16. Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Abstract
PURPOSE: The main objective of this article was to offer practical suggestions, given the existing evidence, for identifying and managing bacterial impetigo, abscess, and cellulitis in ambulatory and hospital settings. METHODS: Five Italian pediatric societies appointed a core working group. In selected conditions, specially trained personnel evaluated quality assessment of treatment strategies according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Only randomized controlled trials (RCTs) and observational studies were included for quality assessment according to the GRADE methodology. MEDLINE, Ovid MEDLINE, EMBASE, and Cochrane Library databases were searched with a strategy combining MeSH and free text terms. FINDINGS: The literature review included 364 articles focusing on impetigo, skin abscess, and cellulitis/orbital cellulitis. The articles included for quality assessment according to the GRADE methodology for impetigo comprised 5 RCTs and 1 observational study; for skin abscess, 10 RCTs and 3 observational studies were included; for cellulitis and erysipelas, 5 RCTs and 5 observational studies were included; and for orbital cellulitis, 8 observational studies were included. Recommendations were formulated according to 4 grades of strength for each specific topic (impetigo, skin abscesses, cellulitis, and orbital cellulitis). Where controversies arose and expert opinion was considered fundamental due to lack of evidence, agreement according to Delphi consensus recommendations was included. IMPLICATIONS: Based on a literature review and on local epidemiology, this article offers practical suggestions for use in both ambulatory and hospital settings for managing the most common bacterial SSTIs.
PURPOSE: The main objective of this article was to offer practical suggestions, given the existing evidence, for identifying and managing bacterial impetigo, abscess, and cellulitis in ambulatory and hospital settings. METHODS: Five Italian pediatric societies appointed a core working group. In selected conditions, specially trained personnel evaluated quality assessment of treatment strategies according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Only randomized controlled trials (RCTs) and observational studies were included for quality assessment according to the GRADE methodology. MEDLINE, Ovid MEDLINE, EMBASE, and Cochrane Library databases were searched with a strategy combining MeSH and free text terms. FINDINGS: The literature review included 364 articles focusing on impetigo, skin abscess, and cellulitis/orbital cellulitis. The articles included for quality assessment according to the GRADE methodology for impetigo comprised 5 RCTs and 1 observational study; for skin abscess, 10 RCTs and 3 observational studies were included; for cellulitis and erysipelas, 5 RCTs and 5 observational studies were included; and for orbital cellulitis, 8 observational studies were included. Recommendations were formulated according to 4 grades of strength for each specific topic (impetigo, skin abscesses, cellulitis, and orbital cellulitis). Where controversies arose and expert opinion was considered fundamental due to lack of evidence, agreement according to Delphi consensus recommendations was included. IMPLICATIONS: Based on a literature review and on local epidemiology, this article offers practical suggestions for use in both ambulatory and hospital settings for managing the most common bacterial SSTIs.
Authors: Susanna Esposito; Claudia De Guido; Marco Pappalardo; Serena Laudisio; Giuseppe Meccariello; Gaia Capoferri; Sofia Rahman; Claudio Vicini; Nicola Principi Journal: Children (Basel) Date: 2022-04-26