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. 2021 Mar;16(3):149-155.
doi: 10.12788/jhm.3529.

Antibiotic Regimens and Associated Outcomes in Children Hospitalized With Staphylococcal Scalded Skin Syndrome

Hannah C Neubauer  1 , Matthew Hall  2 , Michelle A Lopez  1 , Andrea T Cruz  3 , Mary Ann Queen  4 , Dana M Foradori  5 , Paul L Aronson  6 , Jessica L Markham  4 , Jennifer A Nead  7 , Gabrielle Z Hester  8 , Russell J McCulloh  9 , Sowdhamini S Wallace  1
Affiliations

Antibiotic Regimens and Associated Outcomes in Children Hospitalized With Staphylococcal Scalded Skin Syndrome

Hannah C Neubauer et al. J Hosp Med. 2021 Mar.

Abstract

Background: 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).

Objectives: 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.

Results: 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).

Conclusions: 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.

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Figures

FIG
FIG
Flow Chart of Study Population Abbreviations: PHIS, Pediatric Health Information System; SSSS, staphylococcal scalded skin syndrome.
See this image and copyright information in PMC

References

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