Outbreak of staphylococcal scalded skin syndrome among neonates

doi:10.1016/S0163-4453(88)96249-4

Journal of Infection

Volume 16, Issue 1, January 1988, Pages 87-103

https://doi.org/10.1016/S0163-4453(88)96249-4 Get rights and content

Summary

Over a period of 2 months, 12 babies born in the maternity unit at Guy's Hospital developed staphylococcal scalded skin syndrome in two distinct outbreaks. Staphylococci isolated from the babies, together with those from the mothers and attending medical staff were phage-typed. All isolates from the babies were of type 3A/3C. During the first outbreak only one carrier of the epidemic strain (a paediatrician) was found but a further 12 persons were identified as possible carriers during the second outbreak.

In order to confirm the link between outbreaks, all phage group II isolates were subjected to reverse phage-typing, testing for metal-ion resistance, plasmid profiling and in-vivo testing for production of epidermolytic toxin. It was shown that the same epidemic strain of toxin-producing Staphylococcus aureus was responsible for both outbreaks.

The affected neonates responded rapidly to a short course of intravenous flucloxacillin. The outbreak ceased after appropriate treatment of all carriers and the implementation of an extensive disinfection policy within the maternity unit.

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Citation Excerpt :
Some level of staphylococcal disease is probably always present in nurseries,8 most often causing minor skin infections, but hospital neonatal wards have also been frequent and recurring sites of outbreaks. The first nursery epidemic reported in the United States occurred in 1889,9 and subsequent outbreaks occurred throughout the 1900s.10–19 Staphylococcal outbreaks among adults are also common in hospitals, particularly in burn or surgical units,20–22 where the presence of deep wounds and medical devices such as catheters provide environments conducive to the growth of staphylococci.
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Outbreak of staphylococcal scalded skin syndrome among neonates

Summary

J Hosp Infect

Lancet

Die Exfoliative Dermatitis jungener Senglinge

Central zt Kinderheilkunde

Toxic epidermal necrolysis: an eruption resembling scalding of the skin

Br J Dermatol

Abnormal neutrophil chemotaxis and T-lymophocyte function in the staphylococcal scalded skin syndrome in an adult

Infection

Toxic epidermal necrolysis

Nurs Times

Sir Jonathan Hutchinson on toxic epidermal necrolysis — an historical note

Br J Dermatol

Impetigo contagiosa: the association of certain types of Staphylococcus aureus and Streptococcus pyogenes in superficial skin infections

J Hyg (Camb)

Plasmids in epidermolytic strains of Staphylococcus aureus

J Gen Microbiol

Neonatal staphylococcal scalded skin syndrome: massive outbreak due to an unusual phage type

Paediatrics

New type of exfoliatin obtained from staphylococcal strains, belonging to phage groups other than group II, isolated from patients with impetigo and Ritter's disease

Infect Immun

The staphylococcal scalded skin syndrome; experimental model and isolation of a new exfoliative toxin

Pediatr Res

The staphylococcal scalded skin syndrome; isolation and partial characterisation of the exfoliative toxin

J Infect Dis

The staphylococcal scalded skin syndrome: an experimental histochemical and electron microscopic study

Br J Dermatol

Possible binding of epidermolytic toxin to a subcellular fraction of the epidermis

J Dermatol