Microbiology Culture Results and Antibiotic Prescribing in Pediatric Patients With Lymphadenitis

Hosp Pediatr. 2023 Feb 1;13(2):e29-e33. doi: 10.1542/hpeds.2022-006668.

Abstract

Background: Bacterial lymphadenitis is a common reason for antibiotic treatment and hospitalization in children. The literature available addressing the bacterial etiology of lymphadenitis recommends the use of narrow-spectrum agents to cover common pathogens. We suspect that patients at our institution receive unnecessarily broad-spectrum antimicrobial agents. The primary objective of this study was to characterize the microbiology and antibiotic use in lymphadenitis patients.

Methods: Retrospective review of children admitted over a 10-year period with an International Classification of Diseases Ninth or Tenth Edition code for lymphadenitis. Patients were included if they were <18 years old, admitted to the inpatient ward, and had intraoperative lymph node cultures collected.

Results: A total of 131 patients admitted with lymphadenitis had lymph node cultures collected and were included. Seventy-two (72/131; 55%) patients had positive lymph node culture results with pathogenic bacteria. The predominant pathogens were Staphylococcus aureus (56/72; 77.8%) and Streptococcus pyogenes (10/72; 13.9%). The most common inpatient empirical regimen was ampicillin-sulbactam. Of the 72 patients with typical pathogens identified, 80.6% were sensitive to a first-generation cephalosporin, whereas 86.1% were sensitive to a β-lactam/β-lactamase inhibitor.

Conclusion: Patients presenting to our institution with acute bacterial lymphadenitis were predominantly found to have methicillin-susceptible S. aureus lymphadenitis that could be empirically treated with cefazolin. At our institution, there is little advantage to the most commonly used broad-spectrum agent, ampicillin-sulbactam.

MeSH terms

  • Adolescent
  • Ampicillin
  • Anti-Bacterial Agents* / therapeutic use
  • Child
  • Humans
  • Lymphadenitis* / drug therapy
  • Lymphadenitis* / microbiology
  • Lymphadenitis* / surgery
  • Staphylococcus aureus

Substances

  • Anti-Bacterial Agents
  • sultamicillin
  • Ampicillin