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Neonatal staphylococcal scalded skin syndrome: clinical and outbreak containment review

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Abstract

Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated exfoliating skin condition predominated by desquamation and blistering. Neonatal outbreaks have already been reported; however, our outbreak highlights the potential for SSSS following neonatal health promotion measures such as intra-muscular vitamin K administration and metabolic screening (heel prick) as well as effective case containment measures and the value of staff screening. Between February and June 2007, five confirmed cases of neonatal SSSS were identified in full-term neonates born in an Irish regional maternity hospital. All infants were treated successfully. Analysis of contact and environmental screening was undertaken, including family members and healthcare workers. Molecular typing on isolates was carried out. An outbreak control team (OCT) was assembled and took successful prospective steps to prevent further cases. All five Staphylococcus aureus isolates tested positive for exfoliative toxin A, of which two distinct strains were identified on pulsed-field gel electrophoresis analysis. Two cases followed staphylococcal inoculation during preventive measures such as intra-muscular vitamin K administration and metabolic screening (heel prick). None of the neonatal isolates were methicillin resistant. Of 259 hospital staff (70% of staff) screened, 30% were colonised with S. aureus, and 6% were positive for MRSA carriage. This is the first reported outbreak of neonatal SSSS in Ireland. Effective case containment measures and clinical value of OCT is demonstrated. Results of staff screening underlines the need for vigilance and compliance in hand disinfection strategies in maternity hospitals especially during neonatal screening and preventive procedures.

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Acknowledgements

The authors would like to thank consultant paediatricians Dr M Mahony, Dr L Carroll, consultant dermatologist Dr. B Ramsay and the medical, nursing and allied healthcare staff of hospital A and B for their co-operation in the control of the outbreak. Support from Dr C McDonagh-White and the Occupational Health team was greatly appreciated. Data on S. aureus bacteraemia (part of the European Antimicrobial Resistance Surveillance System) were kindly provided by Health Protection Surveillance Centre, Dublin. We are indebted to our co-author Dominic Whyte, who sadly passed away during the preparation of this article, for his contribution.

Conflict of interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Paediatrics, Mid-Western Regional Hospital, Dooradoyle, Limerick, Ireland

    Orla Neylon, Fiona McElligott & Roy K. Philip

  2. Department of Medical Microbiology, Mid-Western Regional Hospital, Limerick, Ireland

    Nuala H. O’Connell, James Powell & Regina Monahan

  3. Infection Prevention & Control Unit, Mid-Western Regional Hospital, Limerick, Ireland

    Barbara Slevin & Liz Boyle

  4. Department of Public Health, Health Service Executive (West), Limerick, Ireland

    Dominic Whyte & Mai Mannix

  5. Staphylococcus Reference Unit, Centre for Infections, Health Protection Agency, London, England, UK

    Angela M. Kearns

Authors
  1. Orla Neylon
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  2. Nuala H. O’Connell
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  3. Barbara Slevin
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  4. James Powell
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  5. Regina Monahan
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  6. Liz Boyle
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  7. Dominic Whyte
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  8. Mai Mannix
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  9. Fiona McElligott
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  10. Angela M. Kearns
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  11. Roy K. Philip
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Corresponding author

Correspondence to Roy K. Philip.

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Neylon, O., O’Connell, N.H., Slevin, B. et al. Neonatal staphylococcal scalded skin syndrome: clinical and outbreak containment review. Eur J Pediatr 169, 1503–1509 (2010). https://doi.org/10.1007/s00431-010-1252-1

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  • DOI: https://doi.org/10.1007/s00431-010-1252-1

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