Clinical, Cosmetic and Investigational Dermatology (Jun 2023)
Associated Outcomes of Different Intravenous Antibiotics Combined with 2% Mupirocin Ointment in the Treatment of Pediatric Patients with Staphylococcal Scalded Skin Syndrome
Abstract
Cong You, Zhiwei Wu, Mingyi Liao, Xiaoying Ye, Longnian Li, Tao Yang Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of ChinaCorrespondence: Longnian Li; Tao Yang, Department of Dermatology and Venereology, Candidate Branch of National Clinical Research Centre for Skin and Immune Diseases, The First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of China, Tel +8614770833995 ; +8618720732351, Email [email protected]; [email protected]: 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
