Staphylococcal Scalded Skin Syndrome: Are We Doing Too Much?

Background Staphylococcal Scalded Skin Syndrome (SSSS) is considered a pediatric emergency requiring inpatient care and prompt treatment to suppress bacterial toxin production. However, diagnostic and management practices vary, and current antibiotic strategies are not well aligned with the latest antimicrobial-stewardship principles. This study aimed to provide a contemporary analysis of SSSS and evaluate current management approaches. Methods We used Epic’s SlicerDicer tool to identify patients aged ≤18 years at Nationwide Children’s Hospital (NCH) from November 13, 2023, to November 14, 2025. Patients with alternate final diagnoses were excluded. We reviewed demographics, clinical features, laboratory findings, and treatment regimens. The study was approved by the NCH Institutional Review Board. Results Of 70 patients identified, 37 (53%) were female. Mean age was 3.2 (range 0.025-15) years. Six patients had eczema; two had asthma. Median duration of illness prior to presentation was 3 days (IQR = 3). Eleven patients (16%) were initially diagnosed with an allergic reaction and treated before admission. Six patients (8.6%) reported fever. Laboratory testing - including complete blood counts, C-reactive protein (CRP), and chemistry panels - was performed in 48 patients (68.5%). Three patients (4%) had an elevated CRP >3 mg/dL. Among 34 patients with wound cultures, 27 grew Methicillin-susceptible S. aureus (MSSA); 17 (63%) were clindamycin-resistant, a higher rate than those observed at other NCH sites. Nasal Methicillin-resistant S. aureus (MRSA) screening, performed in nine patients, was negative in all cases. Among 23 patients who underwent nasal S. aureus PCR screening, 16 grew MSSA with four being clindamycin resistant. Among 43 patients with blood cultures obtained, MSSA bacteremia was identified in three patients, all three being newborns. Median length of stay was 3 days (IQR=1). Median antibiotic treatment duration was 10 days (IQR=0). Most patients received intravenous clindamycin combined with nafcillin or cefazolin during hospitalization and were discharged on cephalexin. Three patients were reevaluated for rash within two weeks after discharge. Conclusion Commonly ordered blood tests and nasal MRSA screenings had little to no impact on patient management or outcomes. MSSA was the predominant pathogen identified and demonstrated higher-than-expected rates of clindamycin resistance. Although limited by sample size, our findings suggest that clindamycin offers minimal added benefit when used alongside beta-lactam antibiotics, and beta-lactam monotherapy may be sufficient. The study will be expanded to include prior years to further analyze antimicrobial susceptibility patterns and inform management strategies.