TOP 48 - Systematizing the Approach to Staphylococcal Scalded Skin Syndrome at Boston Children’s Hospital

Publication Number: 2800.TOP 48

Danielle Newton, Boston Children's Hospital, Boston, MA, United States; Holly J. Roberts, Boston Children's Hospital, Boston, MA, United States; Lisa Rickey, Boston Children's Hospital, Boston, MA, United States; Maria Biancarelli, Boston Children's Hospital, SOUTH WALPOLE, MA, United States; Elizabeth Pingree, Boston Children's Hospital, Boston, MA, United States; Hanna Wardell, Boston Children's Hospital, Boston, MA, United States; Amundam Mancho, Boston Children's Hospital, Boston, MA, United States; Niloufar Paydar-Darian, Boston Children's Hospital, Boston, MA, United States; Allison Hanley, Boston Children's Hospital, Boston, MA, United States; Shannon Cottreau, Boston Children's Hospital, Bridgewater, MA, United States; Alyssa Felt, Boston Children's Hospital, Boston, MA, United States; Chase Yarbrough, Harvard Medical School, Wayland, MA, United States

Background: Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated condition characterized by painful bullae and desquamating lesions secondary to Staphylococcus aureus that typically affects infants and children. Patients often require hospital admission for pain management and IV antibiotics. While no consensus professional guidelines exist for SSSS, published literature provides evidence-based care recommendations.

Objective: We sought to describe the current state diagnostic and therapeutic approach for children admitted to our institution with SSSS, and to identify opportunities to standardize local clinical practice with evidence-based recommendations.

Design/Methods: We performed a retrospective review of patients admitted to Pediatric Hospital Medicine services from 6/1/2024 to 6/1/2025 with a coded diagnosis of SSSS using Epic SlicerDicer to obtain preliminary diagnostic and therapeutic data. We then pursued a chart review through our electronic medical record of a separate cohort to assess for detailed variability in laboratory testing, antibiotic prescription, subspecialty service consults, and wound care regimens. We will then identify key drivers of this practice variation and opportunities for standardization of care through quality improvement methodology, which may include development of a local clinical pathway, integration of clinical decision support tools, and awareness campaigns.

Preliminary

Results:
During the retrospective study period, 53 patients were hospitalized with SSSS (Table 1). Median age at admission was 4 years [IQR 3-5] and median hospital length of stay (LOS) was 3 days [2-4]. We found variability in diagnostic testing with 77% (41/53) having wound cultures, 30% (16/53) having MRSA cultures, and 72% (38/53) having blood tests (blood counts, electrolytes, liver function, and inflammatory markers) obtained. The most prescribed IV antibiotics were oxacillin (55%, 29/53), nafcillin (40%, 21/53), or cefazolin (15%, 8/53) during admission (not mutually exclusive, Figure 1).

Through our in-depth chart review of seventeen separate patients, we additionally found that Dermatology was consulted for all patients, and Infectious Disease was consulted for only one patient. We did not identify a standardized approach to wound care, with recommendations ranging from topical petroleum jelly with or without dressings to topical steroids and mupirocin. In 53% (9/17) of these patients, S. aureus decolonization was recommended. These data demonstrate substantial variability in the evaluation and management of children hospitalized with SSSS.

Demographic characteristics of retrospective cohort


Antibiotic variation among patients in retrospective cohort
Notably, these are not mutually exclusive, so the sum will exceed the number of patients (53)