Background: The molecular epidemiology of S. aureus strains causing staphylococcal scalded skin syndrome (SSSS) in the United States has not been described. We analyzed patient and S. aureus isolate characteristics associated with SSSS in children at Texas Childrens Hospital (TCH) from 2008-2015.
Methods: Patients and S. aureus isolates were identified from an ongoing surveillance study. Patient chart review was performed. Patients with SSSS were identified by ICD9/10 codes through TCH Information Services. Molecular analysis included PCR for agr, pvl, tst, sea-sed, eta, and etb, pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) to determine sequence type (ST).
Results: Cases of SSSS at TCH increased from 5 in 2008 to 42 in 2014 (Figure). For a majority of patients, no cultures were obtained or cultures were negative. Only 28 isolates were available, all MSSA, despite prospective collection. Cases were matched with 3 controls for age, MSSA and skin and soft tissue infection within the time period (Table). All available study cases were from 2013-2015. Twenty-nine percent reported positive rapid strep test and/or scarlatina (mainly prior to admission). Nikolskys sign was noted in 50% of cases. Case and control isolates differed by all molecular markers (Table). Case isolates were mainly of CC121; one isolate lacked both eta and etb (ST5, agr II). No case isolates contained pvl, tst, or seb-sed; etb was uniquely found in all cases but not in controls. The majority of controls were USA300 and pvl+; two ST121 control isolates lacked both eta and etb. Clindamycin resistance was 14% for cases and 18% for controls.
Conclusion: Cases of SSSS are increasing at TCH; most have no cultures obtained or culture-negative specimens. S. aureus strains causing SSSS were likely to be of one clonal group, CC121 and carry eta and etb. We speculate that CC121 was recently introduced to our region and is responsible for the increasing numbers of SSSS cases that have been observed at TCH.
K. G. Hulten,
K. King, None
E. O. Mason Jr., None
L. B. Lamberth, None
S. L. Kaplan, Forest Labs: Grant Investigator , Research support and Site-PI for clinical trial unrelated to presented research
Pfizer: Grant Investigator , Research grant
Cubist: Grant Investigator , Research grant and Site-PI for clinical trial unrelated to presented research
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