Department of Paediatrics, Mid-Western Regional Hospital, Dooradoyle, Limerick, Ireland.
Eur J Pediatr. 2010 Dec;169(12):1503-9. doi: 10.1007/s00431-010-1252-1. Epub 2010 Jul 13.
Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated exfoliating skin condition predominated by desquamation and blistering. Neonatal outbreaks have already been reported; however, our outbreak highlights the potential for SSSS following neonatal health promotion measures such as intra-muscular vitamin K administration and metabolic screening (heel prick) as well as effective case containment measures and the value of staff screening. Between February and June 2007, five confirmed cases of neonatal SSSS were identified in full-term neonates born in an Irish regional maternity hospital. All infants were treated successfully. Analysis of contact and environmental screening was undertaken, including family members and healthcare workers. Molecular typing on isolates was carried out. An outbreak control team (OCT) was assembled and took successful prospective steps to prevent further cases. All five Staphylococcus aureus isolates tested positive for exfoliative toxin A, of which two distinct strains were identified on pulsed-field gel electrophoresis analysis. Two cases followed staphylococcal inoculation during preventive measures such as intra-muscular vitamin K administration and metabolic screening (heel prick). None of the neonatal isolates were methicillin resistant. Of 259 hospital staff (70% of staff) screened, 30% were colonised with S. aureus, and 6% were positive for MRSA carriage. This is the first reported outbreak of neonatal SSSS in Ireland. Effective case containment measures and clinical value of OCT is demonstrated. Results of staff screening underlines the need for vigilance and compliance in hand disinfection strategies in maternity hospitals especially during neonatal screening and preventive procedures.
葡萄球菌性烫伤样皮肤综合征（SSSS）是一种由毒素介导的剥脱性皮肤病，以脱屑和水疱为主要特征。已经有新生儿爆发的报道；然而，我们的爆发事件强调了在新生儿健康促进措施（如肌内注射维生素 K 和代谢筛查（足跟采血））以及有效的病例控制措施和员工筛查之后，可能会发生 SSSS。2007 年 2 月至 6 月期间，爱尔兰一家地区妇产医院的足月新生儿中发现了五例确诊的新生儿 SSSS 病例。所有婴儿均成功治愈。进行了接触者和环境筛查分析，包括家庭成员和医护人员。对分离株进行了分子分型。成立了爆发控制小组（OCT），并采取了成功的前瞻性措施来预防进一步的病例。所有 5 株金黄色葡萄球菌分离株均对表皮松解毒素 A 呈阳性反应，脉冲场凝胶电泳分析显示其中两株为不同株。两例发生在预防措施（如肌内注射维生素 K 和代谢筛查（足跟采血））期间接种金黄色葡萄球菌之后。新生儿分离株均未对甲氧西林耐药。对 259 名医院工作人员（70%的工作人员）进行筛查，30%的人定植有金黄色葡萄球菌，6%的人对耐甲氧西林金黄色葡萄球菌（MRSA）带菌呈阳性。这是爱尔兰首例报道的新生儿 SSSS 爆发事件。有效的病例控制措施和 OCT 的临床价值得到了证明。工作人员筛查结果强调了在妇产医院，尤其是在新生儿筛查和预防措施期间，对手部消毒策略保持警惕和遵守的必要性。
