Treating Staphylococcal Scalded Skin Syndrome in Hospitalized Children

Outcomes research explores antibiotic regimens

By Dana M. Foradori, MD, MEd

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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

Treatment includes supportive measures and antistaphylococcal antibiotics

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?

Exploring other antibiotic regimens

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.*

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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.

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  1. 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(9):530-537.
  2. Hodille E, Rose W, Diep BA, et al. The Role of Antibiotics in Modulating Virulence in Staphylococcus aureus. Clin Microbiol Rev. 2017;30(4):887-917.
  3. Neubauer HC, Hall M, Lopez MA, Cruz AT, Queen MA, Foradori DM, Aronson PL, Markham JL, Nead JA, Hester GZ, McCulloh RJ, Wallace SS. Antibiotic Regimens and Associated Outcomes in Children Hospitalized With Staphylococcal Scalded Skin Syndrome. J Hosp Med 2021;16(3):149-155.