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Delaying acyclovir may lengthen hospital stay for children with eczema
AAP 2011 National Conference
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BOSTON — One day of delay in administration of acyclovir to children admitted to the hospital with eczema herpetica was linked to increases in hospital length of stay, according to results presented here at the American Academy of Pediatrics 2011 National Conference and Exhibition.
Paul L. Aronson, MD, of The Children’s Hospital of Philadelphia, told Infectious Diseases in Children that the aim of the multicenter retrospective cohort study was to provide information on the epidemiology and outcomes of eczema herpeticum in children.
“More importantly, we wanted to determine whether delaying acyclovir initiation effected outcomes in children with eczema herpeticum, particularly with regard to hospital stay and mortality,” he said.
The researchers evaluated 1,331 children aged 2 months to 17 years and found that delay of acyclovir by just one day was associated with increased hospital length of stay. Each additional day of delay after that was associated with bigger increases in length of hospital stay.
“We postulated that that was probably due to misdiagnosis at admission. Children most likely developed herpetic lesions as hospital stay wore on and then were started on acyclovir,” Aronson said. “The good thing is that no child in the whole cohort died, regardless of when acyclovir was initiated. We couldn’t evaluate mortality as an outcome measure, but we do know that children with eczema herpeticum in the acyclovir era do very well.”
Other results indicated that Staphylococcus aureus infection was diagnosed in 30.3% of patients. Bloodstream infections were reported in 3.9% of patients.
“We were surprised at the incidence of bacterial bloodstream infections,” Aronson said. “This means that these children are at risk for acquiring secondary bacterial infections.”
Three days was the median length of hospital stay overall (IQR, 2-5 days). Length of stay was not affected by receipt of topical corticosteroids on day 1 of hospital admission (P=.96).
Fifty-one patients (3.8%) were admitted into the ICU, and 893 patients (67.1%) were administered acyclovir on day 1 of admission. No link between day of acyclovir initiation and route of acyclovir administration was observed (P=.85).
The study was conducted between Jan. 1, 2001, and March 31, 2010. Data were collected from 42 tertiary care children’s hospitals in the Pediatric Health Information System database. — by Rob Volansky
For more information:
- Aronson PL. #12696. Delayed Acyclovir and Outcomes of Children Hospitalized with Eczema Herpeticum. Presented at: AAP 2011 National Conference and Exhibition; Oct. 15-18, 2011; Boston.
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