Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
Children's Hospital Association, Lenexa, Kansas, Children's Mercy Kansas City, Kansas City, Missouri.
J Hosp Med. 2021 Mar;16(3):149-155. doi: 10.12788/jhm.3529.
Controversy exists regarding the optimal antibiotic regimen for use in hospitalized children with staphylococcal scalded skin syndrome (SSSS). Various regimens may confer toxin suppression and/or additional coverage for methicillin-susceptible Staphylococcus aureus (MSSA) or methicillin-resistant S aureus (MRSA).
To describe antibiotic regimens in hospitalized children with SSSS and examine the association between antistaphylococcal antibiotic regimens and patient outcomes.
DESIGN/METHODS: Retrospective cohort study of children hospitalized with SSSS using the Pediatric Health Information System database (2011-2016). Children who received clindamycin monotherapy, clindamycin plus MSSA coverage (eg, nafcillin), or clindamycin plus MRSA coverage (eg, vancomycin) were included. The primary outcome was hospital length of stay (LOS); secondary outcomes were treatment failure and cost. Generalized linear mixed-effects models were used to compare outcomes among antibiotic groups.
Of 1,259 children included, 828 children received the most common antistaphylococcal antibiotic regimens: clindamycin monotherapy (47%), clindamycin plus MSSA coverage (33%), and clindamycin plus MRSA coverage (20%). Children receiving clindamycin plus MRSA coverage had higher illness severity (44%) compared with clindamycin monotherapy (28%) and clindamycin plus MSSA (32%) (P =.001). In adjusted analyses, LOS and treatment failure did not differ among the 3 regimens (P =.42 and P =.26, respectively). Cost was significantly lower for children receiving clindamycin monotherapy and highest in those receiving clindamycin plus MRSA coverage (mean, $4,839 vs $5,348, respectively; P <.001).
In children with SSSS, the addition of MSSA or MRSA coverage to clindamycin monotherapy was associated with increased cost and no incremental difference in clinical outcomes.
对于住院的葡萄球菌性烫伤样皮肤综合征（SSSS）患儿，抗生素的最佳治疗方案存在争议。不同的方案可能会抑制毒素并/或对甲氧西林敏感的金黄色葡萄球菌（MSSA）或耐甲氧西林金黄色葡萄球菌（MRSA）提供额外的覆盖。
描述住院的 SSSS 患儿的抗生素治疗方案，并探讨抗葡萄球菌抗生素方案与患者结局之间的关系。
使用儿科健康信息系统数据库（2011-2016 年）对住院的 SSSS 患儿进行回顾性队列研究。纳入接受克林霉素单药治疗、克林霉素加 MSSA 覆盖（如萘夫西林）或克林霉素加 MRSA 覆盖（如万古霉素）的患儿。主要结局是住院时间（LOS）；次要结局是治疗失败和成本。使用广义线性混合效应模型比较抗生素组之间的结局。
在纳入的 1259 名患儿中，828 名患儿接受了最常见的抗葡萄球菌抗生素方案：克林霉素单药治疗（47%）、克林霉素加 MSSA 覆盖（33%）和克林霉素加 MRSA 覆盖（20%）。与克林霉素单药治疗（28%）和克林霉素加 MSSA（32%）相比，接受克林霉素加 MRSA 覆盖的患儿病情严重程度更高（44%）（P=.001）。在调整后的分析中，3 种方案的 LOS 和治疗失败率没有差异（P=.42 和 P=.26）。接受克林霉素单药治疗的患儿成本明显更低，而接受克林霉素加 MRSA 覆盖的患儿成本最高（分别为$4839 和$5348；P<.001）。
在 SSSS 患儿中，克林霉素单药治疗中添加 MSSA 或 MRSA 覆盖与成本增加相关，而临床结局无明显差异。
