Emergency Department Visits After Body Piercings.

OBJECTIVES: There is a paucity of data describing the frequency and complications of body piercing injuries (BPI) in the United States. METHODS: We conducted a cross-sectional study using the National Electronic Injury Surveillance System (NEISS) to identify emergency department (ED) visits for BPI from 2011-2020 and to estimate prevalence among US individuals ≤24 years of age. Additionally, estimates for infections, requirements for hospitalization/transfer, and exploring significant associations were investigated. RESULTS: A total of 10,912 ED visits extrapolates to a national estimate of 338,972 BPIs in the United States. A majority of BPI involved females (85%), adolescents or young adults (55%), and ears (71%). Foreign bodies comprised 72.6% of BPI. Thirteen percent of ED piercing visits were associated with infection. Of these ED visits for BPI-associated infection, 3% required hospitalization/transfer. In the context of all piercing-associated injuries, injuries to the pubic region were 16.8 times more likely to require hospitalization compared to body piercing injuries of the ear. In the context of all piercing-associated infections, navel (lower trunk), nipple (upper trunk), and oral (mouth) locations were associated with increased odds of infection when compared to BPI infections of the ear. CONCLUSIONS: BPI is a common problem in children, adolescents, and youth. Age and body piercing location significantly impact rates of BPI, infection, and hospitalization/transfer. Further study should identify the total number of annual body piercings in the United States. This could generate targeted counseling and risk reduction interventions aimed at specific groups, especially older children who appear to be at increased risk.

Microbiology and Epidemiology of Orbital Cellulitis in Pediatric and Young Adult Patients.

INTRODUCTION: Using data from the large and geographically diverse Military Health System (MHS) beneficiary population, we aimed to characterize and update the epidemiology and microbiology of pediatric orbital cellulitis given previous data are limited to small, single-center studies. MATERIALS AND METHODS: Following institutional review board approval, we performed a retrospective analysis using the Military Health System admissions, microbiology, and pharmacy data between June 2009 and September 2019. Patients less than 22 years of age with radiological confirmation of orbital cellulitis were included. Demographic data, presence of sinusitis, advanced imaging reports, blood and wound culture results with antibiotic susceptibilities, and antibiotic prescriptions were collected. Descriptive statistics were used to summarize demographic characteristics. Imaging findings were grouped by Chandler's stage (CS), an imaging-based measure of the progressive severity of orbital involvement. A Cochran-Armitage trend test was used to evaluate the relationship between CS and likelihood of positive confirmatory culture. RESULTS: There was a male predominance (66.9%) and 55.5% of subjects had comorbid sinusitis. Of the 130 subjects included, 33.8% had one or more positive cultures, 30.8% had a positive wound culture, and 4.6% had a positive blood culture. The most identified organism was coagulase-negative staphylococci (23.3%), followed by Staphylococcus aureus (18.9%), Streptococcus intermedius (17.8%), and strict anaerobes as a group (13.3%). Gram-negative organisms were rare. Twenty-five percent of S. aureus were methicillin-resistant. Clindamycin resistance was identified in 9% of all S. aureus, 50% of coagulase-negative staphylococci, and 25% of S. intermedius. Clindamycin plus ceftriaxone was the most prescribed empiric antibiotic regimen (36.2%). Likelihood of a positive culture significantly increased with advancing CS. CONCLUSIONS: Orbital cellulitis occurs most frequently in males with sinusitis. Likelihood of positive wound culture is increased with a more advanced CS. Staphylococcus and Streptococcus spp. and anaerobes are the most identified pathogens in orbital cellulitis, while gram-negative organisms are rare. Empiric antibiotic selection should include an anti-methicillin-resistant S. aureus agent combined with a broad-spectrum beta-lactam and anaerobic coverage.

Sixteen Weeks Later: Expanding the Risk Period for Multisystem Inflammatory Syndrome in Children.

Multisystem inflammatory syndrome in children (MIS-C) has been observed in temporal association with coronavirus disease 2019 (COVID-19), typically within 2 to 6 weeks of illness or exposure. We present a case of MIS-C occurring 16 weeks after initial COVID-19 illness to highlight the prolonged period of risk for developing MIS-C.

Multisystem Inflammatory Syndrome in Children during the COVID-19 Pandemic: A Case Report on Managing the Hyperinflammation.

The novel human coronavirus of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has quickly swept throughout the entire world. As the ongoing pandemic has spread, recent studies have described children presenting with a multisystem inflammatory disorder sharing the features of Kawasaki disease (KD) and toxic shock syndrome, now named Multisystem Inflammatory Syndrome in Children (MIS-C). These cases report a similar phenotype of prolonged fever, multisystem involvement, and biomarkers demonstrating marked hyperinflammation that occurs temporally in association with local community spread of SARS-CoV-2. Herein, we describe the presentation, clinical characteristics, and management of an 11-year-old boy with prolonged fever, strikingly elevated inflammatory markers, and profound, early coronary artery aneurysm consistent with a hyperinflammatory, multisystem disease temporally associated with coronavirus disease 2019. We highlight our multidisciplinary team's management with intravenous immunoglobulin, methylprednisolone, and an interleukin-1 receptor antagonist, anakinra, as a strategy to manage this multisystem, hyperinflammatory disease process.