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Wu Y, Wu H, Wu M, Wei W, Wei Y, Li T, Cao C, Yao Z. The Clinical Characteristics and Antimicrobial Resistance of Staphylococcus aureus Isolated from Patients with Staphylococcal Scalded Skin Syndrome (SSSS) in Southwestern China. Antibiotics (Basel) 2024; 13:516. [PMID: 38927182 PMCID: PMC11200482 DOI: 10.3390/antibiotics13060516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/16/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Staphylococcal scalded skin syndrome (SSSS) is a rare, toxin-mediated, desquamating bacterial infectious dermatosis. So far, data from Southwestern China is scarce. This study aimed to investigate the clinical characteristics of SSSS patients in our hospital, the relative proportion of methicillin-resistant Staphylococcus aureus (MRSA) in skin and soft tissue secretions, and the drug sensitivity of S. aureus to better assist dermatologists in the diagnosis and treatment of SSSS. We reviewed the demographic characteristics, clinical manifestations, treatment regimens, therapeutic efficacy, laboratory test results, drug sensitivity, and outcome data of 79 SSSS patients from January 2012 to December 2021. Statistical analysis was performed using t tests and chi-square tests. Among the 79 SSSS patients, MRSA was detected in 35 (44.3%) isolates: 34 community-acquired (CA)-MRSA (97.1%) and 1 hospital-acquired (HA)-MRSA. The SSSS incidence increased annually from 2012 to 2014 and then decreased gradually after peaking in 2015. All the isolates were sensitive to vancomycin, tigecycline, linezolid, moxifloxacin, levofloxacin, and ciprofloxacin; were completely resistant to penicillin; and had low sensitivity to clindamycin and erythromycin. Interestingly, the sensitivity of MRSA to tetracycline increased annually after 2015. The resistance rates to common drugs previously used to treat SSSS increased. These findings may accelerate diagnosis and improve empirical antibiotic use, suggesting that clinicians should prescribe drugs according to antimicrobial susceptibility.
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Affiliation(s)
- Yidan Wu
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; (Y.W.); (T.L.)
- Guangxi Key Laboratory of Mycosis Prevention and Treatment, Nanning 530021, China
| | - Hengfeng Wu
- Department of Clinical Medicine, Guangxi Medical University, Nanning 530021, China; (H.W.); (M.W.); (W.W.); (Y.W.)
| | - Man Wu
- Department of Clinical Medicine, Guangxi Medical University, Nanning 530021, China; (H.W.); (M.W.); (W.W.); (Y.W.)
| | - Wanchen Wei
- Department of Clinical Medicine, Guangxi Medical University, Nanning 530021, China; (H.W.); (M.W.); (W.W.); (Y.W.)
| | - Yuying Wei
- Department of Clinical Medicine, Guangxi Medical University, Nanning 530021, China; (H.W.); (M.W.); (W.W.); (Y.W.)
| | - Tiantian Li
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; (Y.W.); (T.L.)
- Guangxi Key Laboratory of Mycosis Prevention and Treatment, Nanning 530021, China
- Guangxi Scientific and Technological Innovation Cooperation Base of Mycosis Prevention and Control, Nanning 530021, China
| | - Cunwei Cao
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; (Y.W.); (T.L.)
- Guangxi Key Laboratory of Mycosis Prevention and Treatment, Nanning 530021, China
- Guangxi Scientific and Technological Innovation Cooperation Base of Mycosis Prevention and Control, Nanning 530021, China
| | - Zhijian Yao
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; (Y.W.); (T.L.)
- Guangxi Key Laboratory of Mycosis Prevention and Treatment, Nanning 530021, China
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Nguyen QBD, Vu MAN, Hebert AA. Recognizing and Managing Staphylococcal Scalded Skin Syndrome in the Emergency Department. Pediatr Emerg Care 2022; 38:133-135. [PMID: 34744158 DOI: 10.1097/pec.0000000000002564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Staphylococcal scalded skin syndrome is a superficial blistering disorder caused by exfoliative toxin-releasing strains of Staphylococcus aureus. Bacterial toxins are released hematogenously, and after a prodromal fever and exquisite tenderness of skin, patients present with tender erythroderma and flaccid bullae with subsequent superficial generalized exfoliation. The head-to-toe directed exfoliation lasts up to 10 to 14 days without scarring after proper treatment. Children younger than 6 years are predominantly affected because of their lack of toxin-neutralizing antibodies and the immature renal system's inability to excrete the causative exotoxins. The epidemiology, pathophysiology, and essential primary skin lesions used to diagnose staphylococcal scalded skin syndrome are summarized for the pediatric emergency medicine physician.
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Yang T, Wang J, Cao J, Zhang X, Lai Y, Li L, Ye X, You C. Antibiotic-resistant profile and the factors affecting the intravenous antibiotic treatment course of generalized Staphylococcal Scalded Skin Syndrome: a retrospective study. Ital J Pediatr 2021; 47:169. [PMID: 34362428 PMCID: PMC8344213 DOI: 10.1186/s13052-021-01120-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/12/2021] [Indexed: 01/08/2023] Open
Abstract
Background Staphylococcal Scalded Skin Syndrome (SSSS) is caused by a special type of Staphylococcus aureus (S.aureus) which can produce exfoliative toxins. The generalized SSSS is recommended to be admitted and treated with intravenous antibiotics. However, there were limited reports on whether personal and clinical factors can have impacts on the duration of intravenous antibiotic application for pediatric patients with generalized SSSS. We performed a study to assess the factors affecting intravenous antibiotic treatment course of SSSS patients. Additionally, the positive culture rates of S.aureus in different samples and the antibiotic-resistant profile were investigated. Methods Two hundred nineteen patients with generalized SSSS were included. Gender, age, area, season, maximum axillary temperature, white blood cell (WBC) count, C-reactive protein (CRP) level, types of intravenous antibiotics, and types of external antibiotics were recorded as the baseline. Simple linear regression was applied in the univariate analysis to determine the variables with statistical significance and then these variables were further examined in multivariate linear regression model. The positive culture rates of S.aureus in different sample sources were calculated and the drug sensitivity results were statistically compared by pairwise Chi square test. Results According to the multiple linear regression, older ages (β = − 0.01, p < 0.05) and external application of fusidic acid (β = − 1.57, p < 0.05) were associated with shorter treatment course, elevated leukocytes (β = 0.11, p < 0.001) and CRP level (β = 1.64, p < 0.01) were associated with longer treatment course. The positive culture rates of periorificial swabs, throat swabs, and blood samples were 54.55, 30.77, and 5.97% respectively. The resistant rates of levofloxacin (8.33%), gentamycin (8.33%), tetracycline (25%), oxacillin (8.33%), vancomycin (0%) were significantly lower than the ones of erythromycin (100%), trimethoprim-sulfamethoxazole (TMP/SMX) (83.33%), clindamycin (91.67%), penicillin G(100%) (p < 0.001). Conclusion Elevated leukocytes and CRP level indicated prolonged intravenous antibiotic treatment course. Older ages and external application of fusidic acid helped to reduce the treatment course. Compared with blood samples, the culture positive rates of S.aureus in periorificial and throat swabs were higher. Oxacillin and vancomycin resistance was rare and clindamycin resistance was common. Clindamycin monotherapy for SSSS should be avoided.
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Affiliation(s)
- Tao Yang
- Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, No. 23 Qingnian Road, Zhanggong District, Ganzhou, 341000, China
| | - Jiangyi Wang
- Department of Dermatology and Venereology, The General Hospital of Tianjin Medical University, No. 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Junya Cao
- Department of Dermatology and Venereology, The General Hospital of Tianjin Medical University, No. 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Xinyue Zhang
- Department of Dermatology and Venereology, The General Hospital of Tianjin Medical University, No. 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Yun Lai
- Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, No. 23 Qingnian Road, Zhanggong District, Ganzhou, 341000, China
| | - Longnian Li
- Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, No. 23 Qingnian Road, Zhanggong District, Ganzhou, 341000, China
| | - Xiaoying Ye
- Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, No. 23 Qingnian Road, Zhanggong District, Ganzhou, 341000, China
| | - Cong You
- Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, No. 23 Qingnian Road, Zhanggong District, Ganzhou, 341000, China.
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Liy-Wong C, Pope E, Weinstein M, Lara-Corrales I. Staphylococcal scalded skin syndrome: An epidemiological and clinical review of 84 cases. Pediatr Dermatol 2021; 38:149-153. [PMID: 33283348 DOI: 10.1111/pde.14470] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated, blistering skin disorder that mainly affects infants and children. There is limited literature regarding pediatric SSSS. The purpose of this study was to describe the epidemiology, clinical features, and management of pediatric SSSS. METHODS Retrospective cohort study of pediatric patients with a clinical diagnosis of SSSS seen at the Hospital for Sick Children in Toronto, Ontario, Canada, from January 1994 to March 2016. RESULTS We included 84 patients with a clinical diagnosis of SSSS; 49/84 (58%) were male. Mean age of diagnosis was 3.1 ± 2.4 years. All patients presented with erythema and exfoliation, while 64/84 (76%) presented with vesicles/ bullae. Skin tenderness was the most common symptom, present in 68/84 (81%) subjects. Staphylococcus aureus was more commonly isolated from periorificial cultures than from bullae. Mean hospitalization was 4.7 ± 2.3 days. No difference was found in admission duration between children receiving clindamycin and those that did not (3.6 ± 2.2 vs 3.9 ± 2.34 days, P = .63). Skin debridement was the only risk factor leading to more complications and prolonged hospitalization (P = .03). Severe complications were seen in 4 (5%) cases, and no fatalities were observed. CONCLUSIONS Healthcare providers should be aware of SSSS and consider it in the differential diagnosis of infants and children with new onset erythema, exfoliation, and/or vesiculation. Suspected culprit pathogens were more often obtained from periorificial swabs; however, these isolates were not tested for exfoliative toxin to confirm causality. Antibiotic treatment should be guided by sensitivity testing. Addition of clindamycin as an anti-toxin agent had no effect on the duration of hospitalization, and this should be further investigated. Surgical debridement of the skin in patients with SSSS should be discouraged.
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Affiliation(s)
- Carmen Liy-Wong
- Division of Pediatric Medicine, Section of Dermatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Elena Pope
- Division of Pediatric Medicine, Section of Dermatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Miriam Weinstein
- Division of Pediatric Medicine, Section of Dermatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Irene Lara-Corrales
- Division of Pediatric Medicine, Section of Dermatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Neubauer HC, Hall M, Wallace SS, Cruz AT, Queen MA, Foradori DM, Aronson PL, Markham JL, Nead JA, Hester GZ, McCulloh RJ, Lopez MA. Variation in Diagnostic Test Use and Associated Outcomes in Staphylococcal Scalded Skin Syndrome at Children's Hospitals. Hosp Pediatr 2018; 8:530-537. [PMID: 30139766 PMCID: PMC6317540 DOI: 10.1542/hpeds.2018-0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The incidence of staphylococcal scalded skin syndrome (SSSS) is rising, but current practice variation in diagnostic test use is not well described. Our aim was to describe the variation in diagnostic test use in children hospitalized with SSSS and to determine associations with patient outcomes. METHODS We performed a retrospective (2011-2016) cohort study of children aged 0 to 18 years from 35 children's hospitals in the Pediatric Health Information System database. Tests included blood culture, complete blood count, erythrocyte sedimentation rate, C-reactive protein level, serum chemistries, and group A streptococcal testing. K-means clustering was used to stratify hospitals into groups of high (cluster 1) and low (cluster 2) test use. Associations between clusters and patient outcomes (length of stay, cost, readmissions, and emergency department revisits) were assessed with generalized linear mixed-effects modeling. RESULTS We included 1259 hospitalized children with SSSS; 84% were ≤4 years old. Substantial interhospital variation was seen in diagnostic testing. Blood culture was the most commonly obtained test (range 62%-100%), with the most variation seen in inflammatory markers (14%-100%). Between hospital clusters 1 and 2, respectively, there was no significant difference in adjusted length of stay (2.6 vs 2.5 days; P = .235), cost ($4752 vs $4453; P = .591), same-cause 7-day readmission rate (0.8% vs 0.4%; P = .349), or emergency department revisit rates (0.1% vs 0.6%; P = .148). CONCLUSIONS For children hospitalized with SSSS, lower use of diagnostic tests was not associated with changes in outcomes. Hospitals with high diagnostic test use may be able to reduce testing without adversely affecting patient outcomes.
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Affiliation(s)
- Hannah C Neubauer
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas;
| | - Matt Hall
- Department of Biostatistics, Children's Hospital Association, Lenexa, Kansas
| | - Sowdhamini S Wallace
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Andrea T Cruz
- Sections of Pediatric Emergency Medicine and Pediatric Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Mary Ann Queen
- Divisions of Pediatric Hospital Medicine and Infectious Diseases, Children's Mercy Kansas City, Kansas City, Missouri
| | - Dana M Foradori
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Paul L Aronson
- Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Jessica L Markham
- Divisions of Pediatric Hospital Medicine and Infectious Diseases, Children's Mercy Kansas City, Kansas City, Missouri
| | - Jennifer A Nead
- Department of Pediatrics, Upstate Golisano Children's Hospital, Syracuse, New York; and
| | - Gabrielle Z Hester
- Department of Hospital Medicine, Children's Minnesota, Minneapolis, Minnesota
| | - Russell J McCulloh
- Divisions of Pediatric Hospital Medicine and Infectious Diseases, Children's Mercy Kansas City, Kansas City, Missouri
| | - Michelle A Lopez
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
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Arnold JD, Hoek SN, Kirkorian AY. Epidemiology of staphylococcal scalded skin syndrome in the United States: A cross-sectional study, 2010-2014. J Am Acad Dermatol 2018; 78:404-406. [PMID: 29332709 DOI: 10.1016/j.jaad.2017.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 08/25/2017] [Accepted: 09/10/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Justin D Arnold
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
| | - Shelby N Hoek
- George Washington University, Milken Institute School of Public Health, Washington, District of Columbia
| | - A Yasmine Kirkorian
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Children's National Health System, Division of Dermatology, Washington, District of Columbia.
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Staiman A, Hsu DY, Silverberg JI. Epidemiology of staphylococcal scalded skin syndrome in U.S. children. Br J Dermatol 2018; 178:704-708. [PMID: 29077993 DOI: 10.1111/bjd.16097] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Staphylococcal scalded skin syndrome (SSSS) is a blistering dermatosis caused by exfoliative toxins released from Staphylococcus aureus. OBJECTIVES To describe the incidence, costs, length of stay (LOS), comorbidities and mortality of SSSS in U.S. children. METHODS The Nationwide Inpatient Sample 2008-2012 was analysed, including a 20% sample of U.S. hospitalizations and 589 cases of SSSS. RESULTS The mean annual incidence of SSSS was 7·67 (range 1·83-11·88) per million U.S. children, with 45·1 cases per million U.S. infants age < 2 years. In multivariable logistic regression models, SSSS was significantly associated with the following (shown as adjusted odds ratio and 95% confidence interval): female sex (1·12, 1·00-1·25), age (2-5 years: 13·31, 11·82-14·99; 6-10 years: 2·93, 2·35-3·66; 11-17 years: 0·44, 0·31-0·63); race/ethnicity (black: 0·69, 0·58-0·84) and season (winter: 2·04, 1·66-2·50; summer: 3·47, 2·86-4·22; autumn: 3·04, 2·49-3·70), with increasing odds over time (2010-2011: 2·28, 2·07-2·51; 2012: 2·98, 2·69-3·30). The geometric mean (95% confidence interval) LOS and cost of hospitalization for patients with vs. without SSSS were 3·2 (3·0-3·4) vs. 2·4 (2·4-2·5) days and $4624·0 ($4250-$5030) vs. $1872 ($1782·7-$1965). Crude inpatient mortality rates (with 95% confidence intervals) were similar for children with vs. without SSSS (0·33%, 0·00-0·79% vs. 0·36%, 0·34-0·39%). SSSS was associated with other infections, including in the upper respiratory tract and skin. CONCLUSIONS The prevalence of SSSS appears to be increasing over time, and was associated with a number of sociodemographic factors and other infections. Further studies are needed to confirm these findings and reduce rising rates of SSSS.
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Affiliation(s)
| | | | - J I Silverberg
- Departments of Dermatology.,Preventive Medicine.,Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A
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Lamanna O, Bongiorno D, Bertoncello L, Grandesso S, Mazzucato S, Pozzan GB, Cutrone M, Chirico M, Baesso F, Brugnaro P, Cafiso V, Stefani S, Campanile F. Rapid containment of nosocomial transmission of a rare community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) clone, responsible for the Staphylococcal Scalded Skin Syndrome (SSSS). Ital J Pediatr 2017; 43:5. [PMID: 28061866 PMCID: PMC5217574 DOI: 10.1186/s13052-016-0323-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/21/2016] [Indexed: 12/04/2022] Open
Abstract
Background The aims of this study were to identify the source and the transmission pathway for a Staphylococcal Scalded Skin Syndrome (SSSS) outbreak in a maternity setting in Italy over 2 months, during 2014; to implement appropriate control measures in order to prevent the epidemic spread within the maternity ward; and to identify the Methicillin-Resistant Staphylococcus aureus (MRSA) epidemic clone. Methods Epidemiological and microbiological investigations, based on phenotyping and genotyping methods, were performed. All neonates involved in the outbreak underwent clinical and microbiological investigations to detect the cause of illness. Parents and healthcare workers were screened for Staphylococcus aureus to identify asymptomatic carriers. Results The SSSS outbreak was due to the cross-transmission of a rare clone of ST5-CA-MRSA-SCCmecV-spa type t311, exfoliative toxin A-producer, isolated from three neonates, one mother (from her nose and from dermatological lesions due to pre-existing hand eczema) and from a nurse (colonized in her nose by this microorganism). The epidemiological and microbiological investigation confirmed these as two potential carriers. Conclusions A rapid containment of these infections was obtained only after implementation of robust swabbing of mothers and healthcare workers. The use of molecular methodologies for typing was able to identify all carriers and to trace the transmission.
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Affiliation(s)
| | - Dafne Bongiorno
- MMARLab - Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Via Santa Sofia 97, 95123, Catania, Italy
| | | | | | | | | | | | | | | | | | - Viviana Cafiso
- MMARLab - Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Via Santa Sofia 97, 95123, Catania, Italy
| | - Stefania Stefani
- MMARLab - Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Via Santa Sofia 97, 95123, Catania, Italy
| | - Floriana Campanile
- MMARLab - Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, Via Santa Sofia 97, 95123, Catania, Italy.
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Lipový B. A potential new sign in patients with toxic epidermal necrolysis. Burns 2016; 42:1618-1620. [PMID: 27576928 DOI: 10.1016/j.burns.2016.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- B Lipový
- Department of Burns and Reconstructive Surgery, University Hospital Brno, Czech Republic; Medical Faculty, Masaryk University Brno, Czech Republic.
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Paranthaman K, Bentley A, Milne LM, Kearns A, Loader S, Thomas A, Thompson F, Logan M, Newitt S, Puleston R. Nosocomial outbreak of staphyloccocal scalded skin syndrome in neonates in England, December 2012 to March 2013. ACTA ACUST UNITED AC 2014; 19. [PMID: 25166346 DOI: 10.2807/1560-7917.es2014.19.33.20880] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Staphylococcal scalded skin syndrome (SSSS) is a blistering skin condition caused by exfoliative toxin-producing strains of Staphylococcus aureus. Outbreaks of SSSS in maternity settings are rarely reported. We describe an outbreak of SSSS that occurred among neonates born at a maternity unit in England during December 2012 to March 2013. Detailed epidemiological and microbiological investigations were undertaken. Eight neonates were found to be infected with the outbreak strain of S. aureus, of spa type t346, representing a single pulsotype. All eight isolates contained genes encoding exfoliative toxin A (eta) and six of them contained genes encoding toxin B (etb). Nasal swabs taken during targeted staff screening yielded a staphylococcal carriage rate of 21% (17/80), but none contained the outbreak strain. Mass screening involving multi-site swabbing and pooled, enrichment culture identified a healthcare worker (HCW) with the outbreak strain. This HCW was known to have a chronic skin condition and their initial nasal screen was negative. The outbreak ended when they were excluded from work. This outbreak highlights the need for implementing robust swabbing and culture methodswhen conventional techniques are unsuccessful in identifying staff carrier(s). This study adds to the growing body of evidence on the role of HCWs in nosocomial transmission of S. aureus.
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Affiliation(s)
- K Paranthaman
- Public Health England, East Midlands Public Health England Centre, Leicester, United Kingdom
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Handler MZ, Schwartz RA. Staphylococcal scalded skin syndrome: diagnosis and management in children and adults. J Eur Acad Dermatol Venereol 2014; 28:1418-23. [PMID: 24841497 DOI: 10.1111/jdv.12541] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/09/2014] [Indexed: 12/01/2022]
Abstract
Staphylococcal scalded skin syndrome is a potentially life-threatening disorder caused most often by a phage group II Staphylococcus aureus infection. Staphylococcal scalded skin syndrome is more common in newborns than in adults. Staphylococcal scalded skin syndrome tends to appear abruptly with diffuse erythema and fever. The diagnosis can be confirmed by a skin biopsy specimen, which can be expedited by frozen section processing, as staphylococcal scalded skin syndrome should be distinguished from life threatening toxic epidermal necrolysis. Histologically, the superficial epidermis is detached, the separation level being at the granular layer. The diffuse skin loss is due to a circulating bacterial exotoxin. The aetiological exfoliating toxin is a serine protease that splits only desmoglein 1. The exfoliative toxins are spread haematogenously from a localized source of infection, causing widespread epidermal damage at distant sites. Sepsis and pneumonia are the most feared complications. The purpose of this review is to summarize advances in understanding of this serious disorder and provide therapeutic options for both paediatric and adult patients. Recent epidemiological studies have demonstrated that paediatric patients have an increased incidence of Staphylococcal scalded skin syndrome during the summer and autumn. Mortality is less than 10% in children, but is between 40% and 63% in adults, despite antibacterial therapy. Previously, intravenous immunoglobulin had been recommended to combat Staphylococcal scalded skin syndrome, but a recent study associates its use with prolonged hospitalization.
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Affiliation(s)
- M Z Handler
- Department of Dermatology, Rutgers University New Jersey Medical School, Newark, USA
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Li MY, Hua Y, Wei GH, Qiu L. Staphylococcal scalded skin syndrome in neonates: an 8-year retrospective study in a single institution. Pediatr Dermatol 2014; 31:43-7. [PMID: 23557104 DOI: 10.1111/pde.12114] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Staphylococcal scalded skin syndrome (SSSS) is a rare disorder in children. Complications may occur without timely treatment. Mortality in children with SSSS is approximately 4%. Other than a limited number of case reports, data on SSSS in neonates are limited. The objective of the current study was to investigate SSSS in neonates. A retrospective review of neonates with a diagnosis of SSSS from January 2004 to January 2012 was performed. Population distribution, historical features, physical examination findings including laboratory tests, antibiotic therapies, and outcomes were evaluated. Thirty-nine cases were included, 31 (79.5%) in the last 4 years. The mean patient age was 17.4 ± 7.7 days. Boys (25 cases) were more commonly affected, and occurrence during summer and autumn months was more frequent. The face was the most common body part affected and the area most commonly initially affected. Fever, high white blood cell count, and high C-reactive protein levels were uncommon. Pneumonia was the most frequent complication (74.4%). The positive rate of Staphylococcus aureus isolation was low (23.5%). Drug susceptibility tests showed that amoxicillin with clavulanic acid and cephalosporins were effective in practice. The median length of hospitalization was 9.0 days. All of the 39 neonates were cured without scarring. This study established basic epidemiologic characteristics of a group of neonates diagnosed with SSSS. In the presence of a clinical suspicion of SSSS, even with apparently normal laboratory tests, immediate treatment with cephalosporins, β-lactamase-resistant semisynthetic penicillin, or both is advocated.
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Affiliation(s)
- Ming Y Li
- Children's Hospital of Chongqing Medical University, Chongqing, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
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Lamand V, Dauwalder O, Tristan A, Casalegno JS, Meugnier H, Bes M, Dumitrescu O, Croze M, Vandenesch F, Etienne J, Lina G. Epidemiological data of staphylococcal scalded skin syndrome in France from 1997 to 2007 and microbiological characteristics of Staphylococcus aureus associated strains. Clin Microbiol Infect 2012; 18:E514-21. [PMID: 23078129 DOI: 10.1111/1469-0691.12053] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Epidemiological data on staphylococcal scalded skin syndromes (SSSS), including bullous impetigo (BI) and generalized exfoliative syndrome (GES), are scarce. To better characterize SSSS and associated Staphylococcus aureus strains, we conducted a retrospective study of 349 cases collected in France between 1997 and 2007 by the National Reference Centre of Staphylococci. Our results showed a stationary evolution of SSSS cases, with a heterogeneous distribution of cases in France. Although notification was not exhaustive, we estimated an incidence of 0.56 cases/year/million inhabitants, in accordance with previous studies conducted in France and Europe, with a median age of 2 years old and sex ratios of 1. A seasonal effect was observed, with a higher GES/BI ratio in autumn compared with other seasons, which could be explained by the impact of viral co-infection. Genetic analysis of S. aureus strains showed that accessory gene regulator (agr) 4, exfoliative toxin A (eta) and B (etb) genes, staphylococcal and enterotoxin-like O (selo) gene and agr4 etb selo profiles were predominantly associated with GES, whereas agr2 eta and agr4 eta selo were more frequently observed with BI. Only one methicillin-resistant strain was found. Protein A (spa) typing identified two main genotypes: spa clonal complex (CC) 159/sequence-type (ST) 121 (75%) and spaCC346/ST15 (18%). spaCC159 was mainly associated with agr4 eta etb selo, agr4 eta selo and agr4 etb selo, and spaCC346 was mainly associated with agr2 eta, suggesting that French SSSS cases are caused by these two main lineages. However, in a multivariate analysis, only etb was independently associated with GES.
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Affiliation(s)
- V Lamand
- Hospices Civils de Lyon, Centre National de Référence des Staphylocoques, Pierre Bénite, France
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