Children Are Not Small Adults: An Epidemiologic Review of Necrotizing Soft Tissue Infections in Pediatric Patients Compared With Adults

Background: Necrotizing soft tissue infections (NSTI) are rare but potentially life-threatening infections that can occur in both pediatric and adult patients. To date, few studies have examined NSTI in pediatric populations. Thus, the majority of guidelines for diagnosis and managing NSTI are based on adult data. The goal of this study was to utilize a large retrospective database to compare and contrast adult and pediatric cases of NSTI from a single center. Methods: A retrospective review from a single tertiary center identified 446 patients with confirmed NSTI, 27 children (below 18 years of age) and 419 adults. Records were verified for the presence of disease based on retrospective review of a deidentified EMR (notes, reports, etc.). Demographics including age, sex, infection origin, comorbidities, patient presenting symptoms, and mortality rate were compared. Results: Between children and adults with confirmed NF, similar rates of sex and ethnic distribution were observed. Upon admission, pain, erythema, and swelling were present at similar rates between cohorts. The origin and mechanism of infection were markedly different between cohorts with children experiencing extremity infections at double the rate of adults (76.9% vs. 34.1%). In patients with available culture data, tissue culture results were significantly different between cohorts with children developing culture-negative NSTI at more than 5× the rate of adults (20.0% vs. 4.6%). Finally, children had significantly lower mortality rates than adults (3.7% vs. 20.3%). Given this variability, a focused analysis of extremity cases of NSTI was conducted. Similar rates of ICU admission and peak C-reactive protein levels were identified, but adults experienced a significantly greater rate of amputation (5.5% vs. 27.8%) and organ dysfunction (38.9% vs. 76.7%) compared with children. As such, adults still maintained a significantly higher mortality rate compared with children (5.5% vs. 27.8). Conclusion: Cases of pediatric NSTI differ from those of adults, including variable patient outcomes. These unique features raise the question of whether equally aggressive operative management of NSTI, traditionally applied in adults, is necessary for pediatric cases. As such, future studies differentiating NSTI from other severe forms of infection, efforts to optimize treatment, and continued education for adult community providers remain warranted to support physicians treating pediatric cases of NSTI. Level of Evidence: Level III.