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

Article information

Kosin Med J. 2018;33(1):12-19

Publication date (electronic) : 2018 January 21

doi : https://doi.org/10.7180/kmj.2018.33.1.12

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 2017 November 29; 2017 December 18; Accepted 2017 December 28.

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.

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.

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

Table 3.

Antimicrobial susceptibility of Staphylococcus aureus isolates by colonization sites

References

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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)

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 (%)
Antibiotics	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.