Tamborino Agnese, Venturini Elisabetta, Montagnani Carlotta, Bianchi Leila, Indolfi Giuseppe, Chiappini Elena, Galli Luisa, Trapani Sandra
Infectious Disease Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
Pediatric Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
Ital J Pediatr. 2025 Sep 2;51(1):267. doi: 10.1186/s13052-025-02078-5.
Staphylococcal-scalded skin syndrome (SSSS) is a potentially life-threatening disorder characterized by superficial skin blistering caused by exfoliative toxins produced by Staphylococcus aureus. This study aimed to investigate SSSS in a cohort of children admitted at a tertiary pediatric hospital in Italy.
Patients discharged with the diagnosis of staphylococcal infection and of SSSS between January 2010 and March 2023 were retrospectively identified using ICD-9-CM codes (695.81 and 041.1, respectively). Medical records were reviewed to extract epidemiological, clinical, and hematological data, treatment details (type and duration), length of hospitalization, and outcomes.
Among 971 children with staphylococcal infection, 21 (2.1%) were diagnosed with SSSS. The mean age of 36.8 (interquartile range, IQR 8.5-50.7) months, with 86% under 5 years old. Incidence peaked in winter, summer, and autumn (27.3%, respectively), possibly due to viral co-infection. The admissions/year rate did not indicate an upward trend. Almost all children were healthy. No previous trauma, insect bites, drugs, vaccines, or allergy history have been reported; atopic dermatitis has been reported in one girl. Leukocytosis and elevated C-reactive protein were uncommon. Severe complications were seen in three cases (14.3%): one with severe dehydration with hyponatremia, one with sepsis and the last with Herpes Simplex Virus 1 (HSV1) infection. S. aureus was detected by culture from skin lesions in nine cases (42.9%), by real-time polymerase chain reaction (RT-PCR) assay on vesicle fluid in seven (33%), and by throat culture in one (4.7%). Drug susceptibility tests ruled out resistance and all children received intravenous (IV) antibiotics: oxacillin in 76% of patients, while teicoplanin and clindamycin in 19%. The median duration of IV and oral antibiotic therapy was 12.8 days (IQR 10-14). Only one patient was treated with IV immunoglobulin. The median hospitalization length was 7.8 days (IQR 5-9). All our cases had a favorable outcome.
Demographic, clinical. and hematological features of children with SSSS in this study were comparable with those reported in the literature. The improved awareness of pediatricians should faster diagnosis, which is mainly clinical, and early assessment of appropriate management.
葡萄球菌烫伤样皮肤综合征（SSSS）是一种潜在的危及生命的疾病，其特征是由金黄色葡萄球菌产生的剥脱毒素引起的浅表皮肤水疱。本研究旨在调查意大利一家三级儿科医院收治的一组儿童中的SSSS。
使用ICD-9-CM编码（分别为695.81和041.1）对2010年1月至2023年3月期间诊断为葡萄球菌感染和SSSS并出院的患者进行回顾性识别。查阅病历以提取流行病学、临床和血液学数据、治疗细节（类型和持续时间）、住院时间和结局。
在971例葡萄球菌感染儿童中，21例（2.1%）被诊断为SSSS。平均年龄为36.8个月（四分位间距，IQR 8.5 - 50.7），86%的患者年龄在5岁以下。发病率在冬季、夏季和秋季达到峰值（分别为27.3%），可能是由于病毒合并感染。每年的入院率没有上升趋势。几乎所有儿童都很健康。未报告既往有创伤、昆虫叮咬、药物、疫苗或过敏史；有一名女孩报告有特应性皮炎。白细胞增多和C反应蛋白升高并不常见。3例（14.3%）出现严重并发症：1例伴有严重脱水和低钠血症，1例伴有败血症，最后1例伴有单纯疱疹病毒1型（HSV1）感染。9例（42.9%）皮肤病变培养检出金黄色葡萄球菌，7例（33%）水疱液实时聚合酶链反应（RT-PCR）检测检出，1例（4.7%）咽拭子培养检出。药敏试验排除耐药，所有儿童均接受静脉（IV）抗生素治疗：76%的患者使用苯唑西林，19%的患者使用替考拉宁和克林霉素。静脉和口服抗生素治疗的中位持续时间为12.8天（IQR 10 - 14）。只有1例患者接受了静脉注射免疫球蛋白治疗。中位住院时间为7.8天（IQR 5 - 9）。所有病例均预后良好。
本研究中SSSS儿童的人口统计学、临床和血液学特征与文献报道的特征相似。儿科医生意识的提高应能加快主要基于临床的诊断以及对适当治疗的早期评估。
