P3.G125: Clinical Characteristics and Outcomes of Pediatric Staphylococcal Scalded Skin Syndrome (SSSS) at an Inner-City Tertiary Care Center

Background: Staphylococcal Scalded Skin Syndrome (SSSS) is a blistering skin condition caused by a toxin-producing staphylococcus species. SSSS typically begins with tender diffuse erythema, positive Nikolsky sign, bullae formation, and later desquamation, crusting, and facial edema (Patel, 2003). Epidemiologic studies on pediatric SSSS in the United States are limited, with a reported incidence of 7.67 per million children and 45.1 cases per million infants (Staiman, 2018). It commonly affects children less than five years old and has a mortality rate of less than 4% if no additional comorbidities are present (Meshram, 2018). Immature renal function, lack of protective antibodies, and increased desmoglein-1, the target of the exotoxin, are believed to be the factors behind the increased incidence in younger children (Leung, 2018).

The objectives of the study are to determine clinical and microbiological characteristics, treatment, and outcomes along with factors that could help predict the severity of disease in pediatric SSSS.

Methods: A retrospective chart review was performed for admitted patients under 18 years old. Diagnosed with SSSS from 2010 to 2022 where surgery was consulted. Data was collected using the hospital’s medical records and International Classification of Diseases (ICD) codes.

Results: Our patient cohort contained 23 children aged 0-6 years (mean 1.8 years ± 1.9). 39.1% (n=9) of patients were males and 60.9% (n= 14) were females. 34.8% (n=8) of patients were admitted to the pediatric intensive care unit (PICU), while the rest were managed on the general floor. All patients received a burn care/surgical consult due to the primary provider’s perceived severity of SSSS. No mortalities were recorded. Compared to non-PICU, PICU patients had statistically significant increases in hospital length of stay (8.4 ± 3.9 days vs 3.3 ± 1.2 days, (p < .001)), feeding tube days (3.1 days vs. 0 days, (p < .001)) and highest total body surface area (TBSA) affected by SSSS both on admission (33.4% vs 5.8%, (p < .05)) and highest throughout their hospital stay (47.9% vs. 5.9%, (p < .001)). PICU patients were also significantly younger (.63 years old vs 2.5 years old, (p < .05)) Staphylococcus aureus was isolated in 17/23 patients, with two patients having multiple positive cultures. Analyzing all cultures with available susceptibilities, 15/16 were sensitive to methicillin (MSSA), and 12/16 were resistant to clindamycin; the majority received clindamycin (87%) and cefazolin (78.3%) treatment in-patient and oral cephalexin on discharge (65.2%, n=15).

Conclusion: TBSA involvement on admission and age were the most significant predictors of PICU and hospital length of stay and feeding tube days. Despite high clindamycin resistance, the majority received clindamycin treatment likely due to its known anti-toxin effect. This study sheds light on the clinical characteristics of pediatric SSSS and factors impacting the severity of disease.