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

Introduction Staphylococcal Scalded Skin Syndrome (SSSS) is a blistering skin condition caused by a toxin-producing staphylococcus species. Epidemiologic studies on pediatric SSSS in the United States are limited, with a reported incidence of 7.67 cases per million children and 45.1 per million infants. Immature renal function, lack of protective antibodies, and increased exotoxin target desmoglein-1 are hypothesized to increase incidence in younger children. We aimed to determine clinical and microbiological characteristics of pediatric SSSS and factors that could help predict disease severity. 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 study included 23 children aged 0-6 years. PICU patients had statistically significant increases in hospital length of stay, feeding tube days, and highest total body surface area (TBSA) affected by SSSS. PICU patients were also significantly younger. Staphylococcus aureus was isolated in 17/23 patients, with two patients having multiple positive cultures; 15/16 were sensitive to methicillin and 12/16 were resistant to clindamycin. The majority received clindamycin and cefazolin treatment in-patient and oral cephalexin on discharge. Conclusion TBSA involvement on admission and age were the most significant predictors of PICU, hospital length of stay, and feeding tube days. The majority received clindamycin treatment likely due to its known anti-toxin effect despite resistance. This study sheds light on clinical characteristics of pediatric SSSS and factors impacting disease severity.