Abstract
-
Objectives
- Systemic antibiotic therapy with semisynthetic penicillinase-resistant penicillin or vancomycin and clindamycin are recommended for the treatment of staphylococcal scalded skin syndrome (SSSS). This study assessed the rate of antibiotic resistance of Staphylococcus aureus isolated from the anterior nares or skin of children diagnosed with SSSS.
-
Methods
- A retrospective review of the medical records of 25 patients with SSSS between July 2010 and October 2014 was conducted. The clinical characteristics of patients were collected and the antibiotic susceptibility of S. aureus were analyzed using automated systems.
-
Results
- The median age of the patients was 22 months (range: 2-95). Ninety-two percent of patients were less than 5 years of age. Nasal swab samples of all patients and skin swab samples of 17 patients were cultured to isolate S. aureus. Twenty-one (84%) of 25 patients were colonized with methicillin-resistant S. aureus (MRSA). The results of swab samples of the other four patients were no growth or isolation of bacteria other than S. aureus. Among 20 strains isolated from the anterior nares, 1 strain (5%) was methicillin-susceptible S. aureus. All 15 strains isolated from the skin were MRSA. All 21 strains isolated from anterior nares or skin were found to be resistant to clindamycin upon evaluation using automated systems.
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Conclusions
- The rates of methicillin and clindamycin resistance in S. aureus colonized in children with SSSS were very high. Further studies evaluating proper antibiotic regimens and the effectiveness of systemic antibiotic therapy are needed.
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Keywords: Bacterial; Child; Colonization; Drug resistance; Staphylococcal scalded skin syndrome
Fig. 1.Monthly distribution of staphylococcal scalded skin syndrome.
Table 1.Clinical characteristics of 25 children diagnosed with staphylococcal scalded skin syndrome
Variables |
n (%) |
Sex |
Male |
14 (56) |
Female |
11 (44) |
Age (months), median (range) |
22 (2 - 95) |
< 24 |
15 (60) |
24-60 |
8 (32) |
≥ 60 |
2 (8) |
Fever |
7 (28) |
Admission |
24 (96) |
Hospital days, median (range) |
7 (3 - 12) |
Involved location |
Head and neck |
25 (100) |
Extremities |
18 (72) |
Trunk |
22 (88) |
Associated disease |
Atopic dermatitis |
1 (4) |
Acute otitis media |
2 (8) |
Hand foot mouth disease |
1 (4) |
Leukocytosis (≥ 15,000/㎣) |
7/23 (30.4) |
Eosinophilia (≥ 500/㎣) |
3/23 (13) |
Table 2.Results of bacterial cultures using swab specimens from the anterior nares and skin
|
Nasal swab (N = 25) |
Skin swab (N = 17) |
Isolation of S. aureus |
20 (80) |
15 (88) |
MRSA |
19 (76) |
15 (88) |
MSSA |
1 (4) |
0 (0) |
No growth or isolation of bacteria other than S. aureus |
5 (20) |
2 (12) |
Table 3.Antimicrobial susceptibility of Staphylococcus aureus isolates by colonization sites
Antibiotics |
n (%)
|
Anterior nares (N = 20) |
Skin (N = 15) |
Penicillin |
1 (5) |
0 (0) |
Oxacillin |
1 (5) |
0 (0) |
Clindamycin |
0 (0)*
|
0 (0)†
|
Erythromycin |
0 (0) |
1 (6.7) |
Gentamicin |
2 (10) |
0 (0) |
Ciprofloxacin |
20 (100) |
15 (100) |
Rifampin |
20 (100) |
15 (100) |
Vancomycin |
20 (100) |
15 (100) |
Trimethoprim/sulfamethoxazole |
20 (100) |
15 (100) |
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Citations
Citations to this article as recorded by
- Comparison of Clindamycin with Other Anti-staphylococcal Antibiotics for the Treatment of Pediatric Staphylococcal Skin-Scaled Syndrome
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Archives of Pediatric Infectious Diseases.2023;[Epub] CrossRef