Associated Outcomes of Different Intravenous Antibiotics Combined with 2% Mupirocin Ointment in the Treatment of Pediatric Patients with Staphylococcal Scalded Skin Syndrome

Figures & data

Figure 1 Study flowchart of patients and methods.

Abbreviations: SSSS, Staphylococcal Scalded Skin Syndrome; S. aureus, Staphylococcus aureus.

Figure 2 Skin manifestation evolution of a patient with Staphylococcal Scalded Skin Syndrome (SSSS). (A) A patient with SSSS on admission. Skin erythema, blistering, periocular crusting, radial fissuring, exfoliating rash, and positive Nikolsky’s sign were seen on the face. (B) After 3 days of treatment, the erythema subsided, and the blisters dried up and crusted. (C) The same patient after 7 days of treatment, all the erythema resolved, and a few desquamations were left with mild pigmentation and without scarring.

Table 1 Baseline Characteristics of Pediatric Patients with SSSS (n=253)

Characteristics	Amoxicillin-Clavulanic Acid Cases n (n%)/(P25, P75)	Cefathiamidine Cases n (n%)/(P25, P75)	Cefuroxime Cases n (n%)/(P25, P75)	Ceftriaxone Cases n (n%)/(P25, P75)	χ^2/Η	p*
Sex
Male	24(9.47)	48(18.97)	38(15.02)	37(14.62)	2.08	0.56
Female	24(9.47)	34(13.44)	27(10.67)	21(8.30)
Age
<60months	39(15.42)	71(28.06)	55(21.74)	49(19.37)	1.77	0.62
≥60months	9(3.56)	11(4.35)	10(3.95)	9(3.56)
Onset days prior to admission
≤3days	19(7.51)	36(14.23)	33(13.04)	28(11.07)	1.66	0.65
>3days	29(11.46)	46(18.18)	32(12.65)	30(11.86)
Febrile
No	18(7.11)	30(11.86)	20(7.91)	20(7.91)	0.74	0.86
Yes	30(11.86)	52(20.55)	45(17.79)	38(15.02)
WBC count (×10^9/L)	(7.95, 14.35)	(8.15, 14.79)	(9.9, 15.59)	(8.34, 13.96)	2.56	0.47
CRP level
Normal	44(17.39)	78(30.83)	64(25.30)	57(22.53)	4.37	0.22
Elevated	4(1.58)	4(1.58)	1(0.40)	1(0.40)

Note: *Pearson’s chi-square test or Kruskal–Wallis test was used to analyze the differences among different patient groups.

Abbreviations: SSSS, staphylococcal scalded skin syndrome; WBC, white blood cell; CRP, C-reactive protein; P25, 25th percentile; P75, 75th percentile.

Table 2 Antibiotic Sensitivity Test Results of S. aureus Isolated from Patients with SSSS (n=13)

Antibiotics	Resistant	Sensitive	χ^2	p*
	n (n%)	n (n%)
Levofloxacin	2(15.38)	11(84.62)	69.71	<0.0001
Erythromycin	13(100)	0(0)
Tetracycline	4(30.77)	9(69.23)
Clindamycin	12(92.31)	1(7.69)
Oxacillin	2(15.38)	11(84.62)
Penicillin G	13(100)	0(0)
Vancomycin	0(0)	13(100)
Mupirocin	0(0)	13(100)

Notes: *Cochran’s Q test followed by multiple comparison test showed that the sensitivity rates for oxacillin (84.62%), vancomycin (100%), and mupirocin (100%) were significantly higher than those of erythromycin (0), penicillin G (0), and clindamycin (7.69%); the sensitivity rates for oxacillin (84.62%), vancomycin (100%), and mupirocin (100%) were comparable with those of levofloxacin (84.62%) and tetracycline (69.23%); the sensitivity rates for oxacillin (84.62%) and mupirocin (100%) were comparable with those for vancomycin (100%) (p <0.0001).

Abbreviations: S. aureus, Staphylococcus aureus; SSSS, Staphylococcal Scalded Skin Syndrome.

Figure 3 Comparison of the days of treatment course and the total costs of hospitalization among different intravenous antibiotic groups. (A) The differences in the number of days of treatment course among different intravenous antibiotic groups. (B) The differences in the total costs of hospitalization among different intravenous antibiotic groups.

Notes: Kruskal–Wallis tests were used to compare the days of the treatment course and the total costs of hospitalization among different intravenous antibiotic applications. *p <0.05, **p <0.01,****p <0.0001.

Abbreviation: ns, non-significant.

Table 3 Univariate Analysis of Variables Affecting the Treatment Course of Different Intravenous Antibiotics in Patients with SSSS

Variables	Groups	Amoxicillin-Clavulanic Acid		Cefathiamidine		Cefuroxime
		Days of IV Antibiotic Therapy (P25, P75)/r	p*	Days of IV Antibiotic Therapy (P25, P75)/r	p*	Days of IV Antibiotic Therapy (P25, P75)/r	p*
Sex	Male	(6, 7)	0.75	(6, 7)	0.58	(6, 7)	0.1
	Female	(5.5, 7.5)		(6, 7)		(6, 7)
Age	<60months	(6, 7)	0.004	(6, 7.5)	0	(6, 7)	0.002
	≥60months	(5, 6)		(5, 6)		(5, 6)
Onset days prior to admission	≤3days	(6, 8)	0.17	(6, 7)	0.87	(6, 7)	0.49
	>3days	(6, 7)		(6, 7)		(6, 7)
Febrile	No	(6, 7)	0.64	(6, 7)	0.34	(5.5, 7)	0.29
	Yes	(6, 7)		(6, 7)		(6, 7)
WBC count (×10^9/L)		0.10	0.48	0.26	0.02	−0.10	0.44
CRP level	Normal	(6, 7)	1	(6, 7)	0.06	(6, 7)	0.65
	Elevated	(5.5, 8)		(7, 8.5)		(6, 6)

Notes: *Mann–Whitney U-tests were used to analyze the associations between the categorized variables and the number of days of intravenous antibiotics. Spearman’s rank correlation tests were used to analyze the correlations between continuous variables and days of intravenous antibiotics.

Abbreviations: SSSS, staphylococcal scalded skin syndrome; IV, intravenous; P25, 25th percentile; P75, 75th percentile; WBC, white blood cell; CRP, C-reactive protein.

Table 4 Multivariate Analysis of Factors Affecting the Number of Days of Intravenous Antibiotic Application in Patients with SSSS

Variables	Amoxicillin-Clavulanic Acid		Cefathiamidine		Cefuroxime
	β (95% CI)	p*	β (95% CI)	p*	β (95% CI)	p*
Age <60months	Reference	0.001	Reference	0	Reference	0.003
Age ≥60months	−1.48 (−2.29,-0.66)		−1.44 (−2.06,-0.83)		−0.96 (−1.58,-0.34)
WBC count	0.04 (−0.03, 0.12)	0.24	0.05 (0.01, 0.10)	0.03	−0.02 (−0.07, 0.04)	0.52
Normal CRP level	Reference	0.64	Reference	0.03	Reference	0.67
Elevated CRP level	0.27 (−0.89, 1.42)		1.12 (0.14, 2.10)		−0.40 (−2.28, 1.47)

Notes: *A multivariate linear regression model was used to analyze the factors affecting the treatment course of different intravenous antibiotics.

Abbreviations: SSSS, staphylococcal scalded skin syndrome; WBC, white blood cell; CRP, C-reactive protein.