Texas Hospital Sees Rise in Staphylococcal Scalded-Skin Syndrome

By Anne Harding

January 13, 2020

NEW YORK (Reuters Health) - The incidence of staphylococcal scalded skin syndrome (SSSS) - a serious infection that causes peeling, blistering skin and is also known as Ritter disease - among patients at a large Texas hospital has increased over the past decade, new research shows.

"It's very consistent with what has been reported elsewhere in terms of mainly affecting younger children," Dr. Kristina G. Hulten of Baylor College of Medicine and Texas Children's Hospital (TCH) in Houston told Reuters Health by phone.

Dr. Hulten and her colleagues conducted the study after observing a rise in SSSS cases in their ongoing prospective Staphylococcus aureus surveillance database, which was launched in 2001 to investigate increases in community-acquired methicillin-resistant infection.

They identified 387 patients with SSSS treated at TCH in 2008-2017. Over the study period, incidence increased 20-fold, from five cases in 2008 (2.3/10,000 admissions) to 116 in 2017 (52.6/10,000 admissions), the researchers report in The Pediatric Infectious Disease Journal.

Isolates were available for 58 patients treated in 2013-2017. All but one were methicillin susceptible, and 88% belonged to clonal cluster (CC) 121. Twenty-six percent of isolates were clindamycin resistant.

One patient developed recurrent SSSS, while one patient required treatment in a burn unit.

All patients were treated with intravenous antibiotics, including 37 treated definitively with clindamycin only and seven who received clindamycin plus vancomycin, nafcillin or cefazolin.

While a quarter of the isolates showed clindamycin resistance, the relatively low bacterial inoculum involved in SSSS, as well as clindamycin's ability to inhibit toxin expression, means it is still a viable treatment, Dr. Hulten said.

"All of the children that we had isolates from and for whom we studied the course of infection, all of them recovered," she noted.

The reason for the increase in SSSS remains unknown, Dr. Hulton said.

"From the physician's standpoint, it's important to recognize that this has become more common than prior to the study," she said. "It is definitely treatable, and children do still recover. It's usually affecting the younger age group."

SOURCE: https://bit.ly/2t5KJGy The Pediatric Infectious Disease Journal, online January 1, 2020.