Treating Staphylococcal Scalded Skin Syndrome in Hospitalized Children
The incidence of staphylococcal scalded skin syndrome is rising. A new Cleveland Clinic-led study examines treatment outcomes using a large national database.
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Staphylococcal scalded skin syndrome (SSSS) is an exfoliative dermatitis mediated by Staphylococcus aureus toxin, and its incidence is rising. A prior study demonstrated variability in the evaluation of children with SSSS, but the degree of testing did not impact patient outcomes.1
The treatment of SSSS includes both supportive measures and antistaphylococcal antibiotics. Clindamycin has historically been included in treatment to inhibit bacterial protein synthesis.2 However, a paucity of data raises questions about the most effective antibiotic(s) for SSSS. Is clindamycin monotherapy sufficient, or are additional antibiotics more effective?
Our multi-institution team utilized the Pediatric Health Information System database to review outcomes among children admitted to U.S. children’s hospitals with SSSS from 2011-2016.3 The most frequently utilized antibiotic regimens were clindamycin monotherapy, clindamycin + methicillin-resistant S. aureus coverage and clindamycin + methicillin-sensitive S. aureus coverage.*
In patients who received these regimens, we did not find any associated differences in length of stay or treatment failure, even after adjustment for illness severity. Combination therapy was associated with higher cost in this population.
Prospective trials are necessary to confirm these findings, especially in light of evolving S. aureus resistance.
*Additional antibiotic regimens, including MSSA and MRSA-directed monotherapy, were infrequently utilized, and sample size was insufficient for analysis.