Fran Lowry

October 17, 2011

October 17, 2011 (Boston, Massachusetts) — Delaying the start of acyclovir treatment in children who are hospitalized with eczema herpeticum ends up lengthening their hospital stay and increases their risk of developing a hospital-acquired infection, according to research presented here at the American Academy of Pediatrics 2011 National Conference and Exhibition.

The increased length of stay boosts hospital costs but does not adversely affect outcomes in these children, lead author Paul L. Aronson, MD, from The Children's Hospital of Philadelphia, Pennsylvania, said in an oral poster session.

"Eczema herpeticum is relatively uncommon but potentially severe, and there hasn't been much evidence to guide us on how to manage these kids," he told Medscape Medical News. "That was my main impetus for doing the study — to learn more about the epidemiology and outcomes in these kids."

Dr. Paul Aronson

In this multicenter retrospective cohort study, Dr. Aronson and his group identified 1331 children, 2 months to 17 years of age, who had eczema herpeticum and were hospitalized in 42 tertiary children's hospitals throughout the United States from January 1, 2001 to March 31, 2010. They obtained the information from the Pediatric Health Information System database.

Reassuringly, there were no deaths during this period. However, infection with Staphylococcus aureus was diagnosed in 30.3% of patients, and 3.9% had a bloodstream infection. A small number of patients (n = 51; 3.8%) required admission to the intensive care unit.

Roughly two thirds of the patients (n = 893; 67.1%) received acyclovir on day 1 of admission.

Overall, the median length of stay in hospital was 3 days (interquartile range, 2 to 5 days). The delay of acyclovir initiation by 1 day was associated with a 13% increased length of stay (95% confidence interval [CI], 4% to 22%; P = .005). Starting acyclovir on day 3 was associated with a 46% increased length of stay (95% CI, 23% to 72%; P < .001); starting it on days 4 to 7 was associated with a 109% increased length of stay (95% CI, 69% to 157%; P < .001).

The use of topical corticosteroids, common in eczema, was not associated with an increased length of stay, Dr. Aronson reported.

"I hope this provides the beginning of a framework to care for these hospitalized children. While their outcomes are good, delayed acyclovir does potentially make them have worse lesions and increases their length of stay in hospital, which increases costs and puts them at risk for nosocomial infections," he said.

What is needed is the "impetus to be aggressive in treating these kids up front. Future studies will help us better manage these kids who have potentially very severe disease."

Medscape Medical News invited session moderator Daniel A. Rauch, MD, from Mount Sinai School of Medicine, Elmhurst Hospital, Queens, New York, to comment on this study.

"With sick infants, there's always the thought: 'Do I have to cover for herpes?' The downside of doing this is that you are obligated to treat until proven otherwise, and if you are not in a major children's hospital, that test turnaround can be days and days and days. The kid could be there just for the acyclovir," said Dr. Rauch, who was not part of the study.

"Having some guidelines on what the implications of treating are is really helpful and goes part of the way to having a better understanding of how long to treat and so forth."

Dr. Aronson and Dr. Rauch have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2011 National Conference and Exhibition: Abstract 12696. Presented October 16, 2011.

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