Staphylococcal Scalded Skin Syndrome in a Tertiary Pediatric Hospital over an 11-Year Period

Background/Objectives: Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated skin disorder caused by Staphylococcus aureus (S. aureus), mainly affecting young children. This study aimed to describe the epidemiology, clinical features, microbiology, and management of pediatric SSSS and to explore factors associated with culture positivity, antimicrobial resistance, and complications. Methods: Retrospective cohort study of children hospitalized with SSSS at the major tertiary pediatric hospital in Greece, from January 2009 to December 2019. Exploratory association testing and parsimonious logistic regression were performed. Results: Overall, 51 children with a mean (±SD) age 2.5 ± 2 years were identified. Prior to diagnosis, 70.6% (36/51) of children had not received any antibiotic treatment. S. aureus was isolated from cultures in 43.1% (22/51) of cases. Carriage of S. aureus was detected in 34.0% (16/47) of children and 37.0% (10/27) of parents. Antibiotic resistance (%) for S. aureus was penicillin 95.5%, oxacillin 4.5%, erythromycin 4.5%, clindamycin 9.1%, mupirocin 40.9%, and fusidic acid 18.2%. Annual incidence of SSSS was estimated at 0.00-0.32/1000 hospitalizations from 2009 to 2016, but increased after 2017, reaching the highest incidence in 2019 (1.05/1000 hospitalizations); 50.7% of cases occurred in 2018-2019 (p < 0.001). During this period, resistance to oxacillin (MRSA strains) did not change (p = 0.53), whereas resistance to mupirocin increased over time, from 0% in 2009-2014 to 34.6% in 2018-2019 (p = 0.05). Penicillin was excluded from the composite drug-resistance outcome. Child nasal S. aureus carriage was independently associated with positive S. aureus culture (adjusted odds ratio [aOR] 4.18, 95% CI 1.14-15.27; p = 0.031) and with non-penicillin antibiotic resistance (aOR 25.68, 95% CI 2.64-249.50; p = 0.005). Elevated inflammatory markers were independently associated with complications (aOR 13.66, 95% CI 1.47-126.64; p = 0.021). Regarding treatment, clindamycin was the first-line agent in 58.8% (30/51) and was used as monotherapy in 49.0% (25/51). Conclusions: A notable increase in the incidence of SSSS was detected after 2017. Oxacillin resistance remained stable, but mupirocin resistance increased. Child nasal S. aureus carriage was associated with culture positivity and clinically relevant non-penicillin antibiotic resistance. Continuous surveillance is necessary as regional resistance patterns should guide therapy.