Nursery Outbreak of Staphylococcal Scalded Skin Syndrome

Within a seven-day period, three infants born at Harbor General Hospital were readmitted at ages 5 to 13 days with signs of the staphylococcal scalded skin syndrome (two with toxic epidermal necrolysis and one with bullous impetigo). From all three infants, isolates ofStaphylococcus aureusdemonstrated bacteriocin-like activity againstStaphylococcus502A. A nurse in the newborn area was found to be a persistent nasal carrier of aStaphylococcuswith bacteriocin-like activity. All strains with this activity were subsequently phage-typed as type 71. Because she was a possible source of the outbreak, the nurse-carrier was removed from the nursery and no subsequent cases occurred. The use of bacteriocin-like activity proved a simple and reliable marker of the epidemic staphylococcal strain in screening staphylococci from cases and carriers and in management of the outbreak.