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Original Article
Antibiotic resistance of Staphylococcus aureus colonized in children with staphylococcal scalded skin syndrome
Seom Gim Kong
Kosin Medical Journal 2018;33(1):12-19.
DOI: https://doi.org/10.7180/kmj.2018.33.1.12
Published online: January 21, 2018

Department of pediatrics, Kosin University College of Medicine, Busan, Korea

Corresponding Author: Seom Gim Kong, Department of pediatrics, Kosin University College of Medicine, 262, Gamcheon-ro, Seo-gu, Busan 49267, Korea Tel: +82-51-990-6278 Fax: +82-51-990-3065 E-mail: ana313@hanmail.net
• Received: November 29, 2017   • Accepted: December 28, 2017

Copyright © 2018 Kosin University School of Medicine Proceedings

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • 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.
  • 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.
  • Keywords: Bacterial; Child; Colonization; Drug resistance; Staphylococcal scalded skin syndrome
Fig. 1.
Monthly distribution of staphylococcal scalded skin syndrome.
kmj-33-12f1.jpg
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)

Data are presented n (%).

Abbreviations: MRSA, Methicillin-resistant Staphylococcus aureus; MSSA, Methicillin-seusceptible Staphylococcus aureus

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)

*N = 18. The results of two isolates were not reported.

†N = 13. The result of one isolate was not reported. The other was erythromycin-resistant and clindamycin-susceptible strain, but the double-disk diffusion test was not conducted.

  • 1.Lillibridge CB, Melish ME, Glasgow LA. Site of action of exfoliative toxin in the staphylococcal scalded-skin syndrome. Pediatrics 1972;50:728–38.ArticlePubMed
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    • Comparison of Clindamycin with Other Anti-staphylococcal Antibiotics for the Treatment of Pediatric Staphylococcal Skin-Scaled Syndrome
      Houman Hashemian, Majid Asgharzadeh, Seyed Lida Baghaei, Seyyedeh Azade Hoseini Nouri
      Archives of Pediatric Infectious Diseases.2023;[Epub]     CrossRef

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      Antibiotic resistance of Staphylococcus aureus colonized in children with staphylococcal scalded skin syndrome
      Kosin Med J. 2018;33(1):12-19.   Published online January 21, 2018
      DOI: https://doi.org/10.7180/kmj.2018.33.1.12
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    Figure
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    Antibiotic resistance of Staphylococcus aureus colonized in children with staphylococcal scalded skin syndrome
    Image
    Fig. 1. Monthly distribution of staphylococcal scalded skin syndrome.

    Fig. 1.

    Antibiotic resistance of Staphylococcus aureus colonized in children with staphylococcal scalded skin syndrome

    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)

    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)

    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)
    Table 1. Clinical characteristics of 25 children diagnosed with staphylococcal scalded skin syndrome

    Table 2. Results of bacterial cultures using swab specimens from the anterior nares and skin

    Data are presented n (%).

    Abbreviations: MRSA, Methicillin-resistant Staphylococcus aureus; MSSA, Methicillin-seusceptible Staphylococcus aureus

    Table 3. Antimicrobial susceptibility of Staphylococcus aureus isolates by colonization sites

    N = 18. The results of two isolates were not reported.

    N = 13. The result of one isolate was not reported. The other was erythromycin-resistant and clindamycin-susceptible strain, but the double-disk diffusion test was not conducted.

    Table 1.

    Table 2.

    Table 3.

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