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Staphylococcal Scalded Skin Syndrome, Identification, and Wound Care: A Case Report Series
Katherine E McKeown1, Rachel B Baker
1Neonatal Intensive Care Unit, TriHealth, Good Samaritan Hospital, Cincinnati, Ohio (Ms McKeown); and Nursing Administration, TriHealth, Cincinnati, Ohio (Dr Baker).
Introduction:
Methicillin-susceptible Staphylococcus aureus (MSSA) infections cause diseases ranging from localized skin infections to serious invasive infections. Neonates are immunosuppressed, placing them at increased risk for MSSA infections, including staphylococcal scalded skin syndrome (SSSS), a rare severe skin presentation of MSSA.
Clinical Findings:
We present a case series of 3 preterm infants with SSSS receiving care at a level 3 neonatal intensive care unit.
Primary Diagnosis:
The infants presented with symptoms of sepsis, including temperature instability, apnea, and bradycardia episodes. The infants had peeling skin at sites of external pressure, including peripheral intravenous (IV) sites, under dressings, or where devices had been in contact with skin.
Interventions:
The infants were soaked in a tub with gel baby wash and water to remove leads without traumatizing the skin. Laboratory values were drawn, and cultures were obtained. Wound care was provided using mupirocin, soft silicone mesh wound contact layer, and soft cotton bandage gauze. Supportive respiratory care was provided, and IV antibiotics were administered.
Outcomes:
The infants were discharged to their homes with intact skin. One infant experienced a loss of pigment that persisted several weeks. All patients were without scarring by early childhood.
Practice Recommendations:
Thorough assessment and careful hygiene of neonates' skin is crucial. MSSA is an infection that can appear on the skin. It is important to quickly diagnose and treat this type of infection, especially when it presents as a localized pustule, boil, tear, peeling, or crust before it becomes systemic.
Insights
Methicillin-susceptible Staphylococcus aureus (MSSA) can cause severe skin infections like staphylococcal scalded skin syndrome (SSSS) in newborns. Prompt diagnosis and treatment are vital for preventing systemic illness and ensuring full skin recovery in neonates.
Area of Science:
- Neonatal Intensive Care
- Pediatric Dermatology
- Infectious Diseases
Background:
- Neonates are vulnerable to Methicillin-susceptible Staphylococcus aureus (MSSA) infections due to their immature immune systems.
- Staphylococcal scalded skin syndrome (SSSS) is a severe skin manifestation of MSSA, posing significant risk to newborns.
Observation:
- A case series involving three preterm infants with SSSS in a level 3 NICU is presented.
- Infants exhibited sepsis symptoms and characteristic skin peeling at pressure sites and device contact areas.
Findings:
- Treatment involved gentle cleansing, topical mupirocin, specialized wound dressings, and systemic antibiotics.
- All infants recovered with intact skin, though one had temporary pigment loss; no scarring was observed long-term.
Implications:
- Emphasizes the critical need for vigilant neonatal skin assessment and hygiene practices.
- Highlights the importance of early recognition and intervention for MSSA skin infections to prevent severe outcomes.
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