Purpose: To compare treatment duration, influencing factors, and costs among intravenous antibiotic groups combined with 2% mupirocin ointment for treating staphylococcal scalded skin syndrome (SSSS).
Patients and Methods: Sex, age, onset days before admission, febrile status, white blood cell (WBC) count, and C-reactive protein (CRP) level were recorded as baseline characteristics for 253 included patients. The antibiotic sensitivity results were statistically compared by Cochran’s Q test. Kruskal–Wallis tests were used to compare days and the total costs of hospitalization with different intravenous antibiotic applications. Mann–Whitney U -tests or Spearman’s rank correlation tests were used for the univariate analysis. Finally, a multivariate linear regression model was employed to determine the variables with statistical significance.
Results: The sensitivity rates of oxacillin (84.62%), vancomycin (100%), and mupirocin (100%) were significantly higher than those of clindamycin (7.69%) (p < 0.0001). The duration of intravenous ceftriaxone administration was significantly longer than that of amoxicillin-clavulanic acid, cefathiamidine, and cefuroxime (p < 0.01). The total hospitalization costs for cefathiamidine were significantly higher than those for amoxicillin-clavulanic acid and cefuroxime (p < 0.05). According to the multiple linear regression, ages ≥ 60 months old were correlated with shorter treatment duration (β=− 1.48, [95% CI: − 2.29, − 0.66] for amoxicillin-clavulanic acid, and β=− 1.44, [95% CI: − 2.06, − 0.83] for cefathiamidine, and β=− 0.96, [95% CI: − 1.58, − 0.34] for cefuroxime) (all p < 0.01). In multivariate analysis for cefathiamidine, higher WBC count (β=0.05, [95% CI: 0.01, 0.10], p < 0.05) and CRP level (β=1.12, [95% CI: 0.14, 2.10], p < 0.05) were associated with longer treatment course.
Conclusion: Oxacillin resistance was rare, and clindamycin resistance was high in pediatric patients with SSSS in our district. Intravenous amoxicillin-clavulanic acid and cefuroxime combined with topical mupirocin were favorable due to a shorter intravenous treatment course and lower costs. Younger age, elevated WBC count, and CRP levels could indicate a longer course of treatment with intravenous antibiotics.
Keywords: staphylococcal scalded skin syndrome, Staphylococcus aureus , amoxicillin-clavulanic acid, cephalosporins, mupirocin, intravenous antibiotic treatment course