Molecular epidemiology of staphylococcal scalded skin syndrome in premature infants

Lisa Saiman, Kathleen Jakob, Kathryn Holmes, Susan Whittier, Maria C. Garzon, James V. Rago, Patrick M. Schlievert, Phyllis Della-Latta

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background. Outbreaks of nosocomial staphylococcal scalded skin syndrome (SSSS) in infants have been well-described associated with the well baby nursery or delivery room. We describe two cases of SSSS in very low birth weight infants in a neonatal intensive care unit (NICU) and the success of infection control strategies used to prevent an outbreak. Methods. Staphylococcal scalded skin syndrome was diagnosed in two infants in the NICU: Case I (a 47-day-old, formerly 530-g female); and Case II diagnosed 48 h later (a 41-day old, formerly 706-g female). Multiple infection control measures were implemented: (1) isolation and intravenous antibiotic treatment of cases; (2) placement of exposed infants into a cohort; (3) prophylactic mupirocin treatment of the anterior nares of all infants in the NICU and staff colonized with Staphylococcus aureus; and (4) personnel hand washing with hexachlorophene. Detection of exfoliative toxin A and studies to determine the genetic relatedness of S. aureus strains isolated from patients and staff were performed. Results. In addition to the two SSSS cases, S. aureus was isolated from 2 of 12 (17%) exposed asymptomatic infants, 2 of 20 (10%) ancillary staff, 8 of 30 (27%) nurses and 6 of 24 (25%) physicians. Exfoliative toxin A-producing strains were isolated from both cases and one asymptomatic infant. No toxin was expressed by strains isolated from staff. Pulse field gel electrophoresis demonstrated genetically identical strains of S. aureus from the two SSSS cases and the asymptomatic infant, whereas three staff members harbored strains genetically related to the case strain. Unexpectedly two additional unique clusters of genetically related S. aureus strains were identified from the surveillance cultures. Conclusions. This report documents the rare occurrence of nosocomial SSSS attributed to transmission in the NICU among extremely low birth weight infants. Multiple infection control strategies were effective in limiting the outbreak. Molecular epidemiology investigation supported a unique S. aureus strain responsible for this event and the presence of bidirectional spread between staff and patients of non-toxin-producing strains.

Original languageEnglish (US)
Pages (from-to)329-334
Number of pages6
JournalPediatric Infectious Disease Journal
Volume17
Issue number4
DOIs
StatePublished - Apr 1998
Externally publishedYes

Fingerprint

Staphylococcal Scalded Skin Syndrome
Molecular Epidemiology
Premature Infants
Staphylococcus aureus
Neonatal Intensive Care Units
Exfoliatins
Infection Control
Disease Outbreaks
Hexachlorophene
Extremely Low Birth Weight Infant
Mupirocin
Delivery Rooms
Hand Disinfection
Very Low Birth Weight Infant
Nurseries
Electrophoresis
Gels
Nurses
Anti-Bacterial Agents
Physicians

Keywords

  • Epidemiology
  • Prematurity
  • Staphylococcal scalded skin syndrome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)

Cite this

Molecular epidemiology of staphylococcal scalded skin syndrome in premature infants. / Saiman, Lisa; Jakob, Kathleen; Holmes, Kathryn; Whittier, Susan; Garzon, Maria C.; Rago, James V.; Schlievert, Patrick M.; Della-Latta, Phyllis.

In: Pediatric Infectious Disease Journal, Vol. 17, No. 4, 04.1998, p. 329-334.

Research output: Contribution to journalArticle

Saiman, L, Jakob, K, Holmes, K, Whittier, S, Garzon, MC, Rago, JV, Schlievert, PM & Della-Latta, P 1998, 'Molecular epidemiology of staphylococcal scalded skin syndrome in premature infants', Pediatric Infectious Disease Journal, vol. 17, no. 4, pp. 329-334. https://doi.org/10.1097/00006454-199804000-00012
Saiman, Lisa ; Jakob, Kathleen ; Holmes, Kathryn ; Whittier, Susan ; Garzon, Maria C. ; Rago, James V. ; Schlievert, Patrick M. ; Della-Latta, Phyllis. / Molecular epidemiology of staphylococcal scalded skin syndrome in premature infants. In: Pediatric Infectious Disease Journal. 1998 ; Vol. 17, No. 4. pp. 329-334.
@article{1241b4273ca54e229bb7e59b469afc17,
title = "Molecular epidemiology of staphylococcal scalded skin syndrome in premature infants",
abstract = "Background. Outbreaks of nosocomial staphylococcal scalded skin syndrome (SSSS) in infants have been well-described associated with the well baby nursery or delivery room. We describe two cases of SSSS in very low birth weight infants in a neonatal intensive care unit (NICU) and the success of infection control strategies used to prevent an outbreak. Methods. Staphylococcal scalded skin syndrome was diagnosed in two infants in the NICU: Case I (a 47-day-old, formerly 530-g female); and Case II diagnosed 48 h later (a 41-day old, formerly 706-g female). Multiple infection control measures were implemented: (1) isolation and intravenous antibiotic treatment of cases; (2) placement of exposed infants into a cohort; (3) prophylactic mupirocin treatment of the anterior nares of all infants in the NICU and staff colonized with Staphylococcus aureus; and (4) personnel hand washing with hexachlorophene. Detection of exfoliative toxin A and studies to determine the genetic relatedness of S. aureus strains isolated from patients and staff were performed. Results. In addition to the two SSSS cases, S. aureus was isolated from 2 of 12 (17{\%}) exposed asymptomatic infants, 2 of 20 (10{\%}) ancillary staff, 8 of 30 (27{\%}) nurses and 6 of 24 (25{\%}) physicians. Exfoliative toxin A-producing strains were isolated from both cases and one asymptomatic infant. No toxin was expressed by strains isolated from staff. Pulse field gel electrophoresis demonstrated genetically identical strains of S. aureus from the two SSSS cases and the asymptomatic infant, whereas three staff members harbored strains genetically related to the case strain. Unexpectedly two additional unique clusters of genetically related S. aureus strains were identified from the surveillance cultures. Conclusions. This report documents the rare occurrence of nosocomial SSSS attributed to transmission in the NICU among extremely low birth weight infants. Multiple infection control strategies were effective in limiting the outbreak. Molecular epidemiology investigation supported a unique S. aureus strain responsible for this event and the presence of bidirectional spread between staff and patients of non-toxin-producing strains.",
keywords = "Epidemiology, Prematurity, Staphylococcal scalded skin syndrome",
author = "Lisa Saiman and Kathleen Jakob and Kathryn Holmes and Susan Whittier and Garzon, {Maria C.} and Rago, {James V.} and Schlievert, {Patrick M.} and Phyllis Della-Latta",
year = "1998",
month = "4",
doi = "10.1097/00006454-199804000-00012",
language = "English (US)",
volume = "17",
pages = "329--334",
journal = "Pediatric Infectious Disease Journal",
issn = "0891-3668",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Molecular epidemiology of staphylococcal scalded skin syndrome in premature infants

AU - Saiman, Lisa

AU - Jakob, Kathleen

AU - Holmes, Kathryn

AU - Whittier, Susan

AU - Garzon, Maria C.

AU - Rago, James V.

AU - Schlievert, Patrick M.

AU - Della-Latta, Phyllis

PY - 1998/4

Y1 - 1998/4

N2 - Background. Outbreaks of nosocomial staphylococcal scalded skin syndrome (SSSS) in infants have been well-described associated with the well baby nursery or delivery room. We describe two cases of SSSS in very low birth weight infants in a neonatal intensive care unit (NICU) and the success of infection control strategies used to prevent an outbreak. Methods. Staphylococcal scalded skin syndrome was diagnosed in two infants in the NICU: Case I (a 47-day-old, formerly 530-g female); and Case II diagnosed 48 h later (a 41-day old, formerly 706-g female). Multiple infection control measures were implemented: (1) isolation and intravenous antibiotic treatment of cases; (2) placement of exposed infants into a cohort; (3) prophylactic mupirocin treatment of the anterior nares of all infants in the NICU and staff colonized with Staphylococcus aureus; and (4) personnel hand washing with hexachlorophene. Detection of exfoliative toxin A and studies to determine the genetic relatedness of S. aureus strains isolated from patients and staff were performed. Results. In addition to the two SSSS cases, S. aureus was isolated from 2 of 12 (17%) exposed asymptomatic infants, 2 of 20 (10%) ancillary staff, 8 of 30 (27%) nurses and 6 of 24 (25%) physicians. Exfoliative toxin A-producing strains were isolated from both cases and one asymptomatic infant. No toxin was expressed by strains isolated from staff. Pulse field gel electrophoresis demonstrated genetically identical strains of S. aureus from the two SSSS cases and the asymptomatic infant, whereas three staff members harbored strains genetically related to the case strain. Unexpectedly two additional unique clusters of genetically related S. aureus strains were identified from the surveillance cultures. Conclusions. This report documents the rare occurrence of nosocomial SSSS attributed to transmission in the NICU among extremely low birth weight infants. Multiple infection control strategies were effective in limiting the outbreak. Molecular epidemiology investigation supported a unique S. aureus strain responsible for this event and the presence of bidirectional spread between staff and patients of non-toxin-producing strains.

AB - Background. Outbreaks of nosocomial staphylococcal scalded skin syndrome (SSSS) in infants have been well-described associated with the well baby nursery or delivery room. We describe two cases of SSSS in very low birth weight infants in a neonatal intensive care unit (NICU) and the success of infection control strategies used to prevent an outbreak. Methods. Staphylococcal scalded skin syndrome was diagnosed in two infants in the NICU: Case I (a 47-day-old, formerly 530-g female); and Case II diagnosed 48 h later (a 41-day old, formerly 706-g female). Multiple infection control measures were implemented: (1) isolation and intravenous antibiotic treatment of cases; (2) placement of exposed infants into a cohort; (3) prophylactic mupirocin treatment of the anterior nares of all infants in the NICU and staff colonized with Staphylococcus aureus; and (4) personnel hand washing with hexachlorophene. Detection of exfoliative toxin A and studies to determine the genetic relatedness of S. aureus strains isolated from patients and staff were performed. Results. In addition to the two SSSS cases, S. aureus was isolated from 2 of 12 (17%) exposed asymptomatic infants, 2 of 20 (10%) ancillary staff, 8 of 30 (27%) nurses and 6 of 24 (25%) physicians. Exfoliative toxin A-producing strains were isolated from both cases and one asymptomatic infant. No toxin was expressed by strains isolated from staff. Pulse field gel electrophoresis demonstrated genetically identical strains of S. aureus from the two SSSS cases and the asymptomatic infant, whereas three staff members harbored strains genetically related to the case strain. Unexpectedly two additional unique clusters of genetically related S. aureus strains were identified from the surveillance cultures. Conclusions. This report documents the rare occurrence of nosocomial SSSS attributed to transmission in the NICU among extremely low birth weight infants. Multiple infection control strategies were effective in limiting the outbreak. Molecular epidemiology investigation supported a unique S. aureus strain responsible for this event and the presence of bidirectional spread between staff and patients of non-toxin-producing strains.

KW - Epidemiology

KW - Prematurity

KW - Staphylococcal scalded skin syndrome

UR - http://www.scopus.com/inward/record.url?scp=0031959060&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031959060&partnerID=8YFLogxK

U2 - 10.1097/00006454-199804000-00012

DO - 10.1097/00006454-199804000-00012

M3 - Article

VL - 17

SP - 329

EP - 334

JO - Pediatric Infectious Disease Journal

JF - Pediatric Infectious Disease Journal

SN - 0891-3668

IS - 4

ER -