Neonatal Mastitis and Concurrent Serious Bacterial Infection.

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Describe the clinical presentation, prevalence, and outcomes of concurrent serious bacterial infection (SBI) among infants with mastitis.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.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.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.

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Authors: Ron L Kaplan, Andrea T Cruz, Kenneth A Michelson, Constance McAneney, Mercedes M Blackstone, Christopher M Pruitt, Nipam Shah, Kathleen A Noorbakhsh, Thomas J Abramo, Richard D Marble, Leah Middelberg, Kathleen Smith, Nirupama Kannikeswaran, David Schnadower, Geetanjali Srivastava, Amy D Thompson, Roni D Lane, Julia F Freeman, Kelly R Bergmann, Oihane Morientes, James Gerard, Oluwakemi Badaki-Makun, Usha Avva, Pradip P Chaudhari, Stephen B Freedman, Margaret Samuels-Kalow, Elizabeth Haines, Jonathan Strutt, Kajal Khanna, Cheryl Vance, Lalit Bajaj