Comparison of Empiric Antibiotics With and Without MRSA Coverage in Staphylococcal Scalded Skin Syndrome

Treatment of staphylococcal scalded skin syndrome (SSSS) typically covers methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA). However, limited data exist to show an optimal antibiotic regimen. We hypothesized that empiric antibiotic treatment without MRSA coverage is noninferior to empiric treatment with MRSA coverage for children hospitalized with SSSS.

We conducted a retrospective cohort noninferiority analysis. Patients with SSSS admitted from January 2014 to October 2024 to our quaternary care children's hospital were included. Patients who received antibiotics before presentation were excluded. Hospital length of stay (LOS) and return visits within 2 weeks of discharge were compared between patients with and without MRSA coverage. Demographics, culture data, and antibiotics were observed.

A total of 187 patients were included; 40% received treatment without MRSA coverage. Four patients, all aged 0 to 2 months, had bacteremia. We observed significant variation in antibiotics and decreased use of MRSA coverage over time. The LOS in patients without MRSA coverage was 2.51 days (SD, 1.66) vs 2.98 days (SD, 2.31) in patients with MRSA coverage (P = .11). In adjusted models, LOS was 34% longer for patients with MRSA coverage (P = .11). Two patients in the study were readmitted.

In our single-center study of children hospitalized with SSSS, treatment without MRSA coverage was associated with a shorter LOS compared with treatment with MRSA coverage. There was no statistical difference in return visits within 2 weeks of discharge. If future studies support our findings, empiric antibiotic regimens without MRSA coverage could provide multiple benefits, including promoting antimicrobial stewardship.