Antibiotic Regimens and Associated Outcomes in Children Hospitalized With Staphylococcal Scalded Skin Syndrome.
Journal
Journal of hospital medicine
ISSN: 1553-5606
Titre abrégé: J Hosp Med
Pays: United States
ID NLM: 101271025
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
07
05
2020
accepted:
01
09
2020
pubmed:
23
2
2021
medline:
19
8
2021
entrez:
22
2
2021
Statut:
ppublish
Résumé
Controversy exists regarding the optimal antibiotic regimen for use in hospitalized children with staphylococcal scalded skin syndrome (SSSS). Various regimens may confer toxin suppression and/or additional coverage for methicillin-susceptible Staphylococcus aureus (MSSA) or methicillin-resistant S aureus (MRSA). To describe antibiotic regimens in hospitalized children with SSSS and examine the association between antistaphylococcal antibiotic regimens and patient outcomes. Retrospective cohort study of children hospitalized with SSSS using the Pediatric Health Information System database (2011-2016). Children who received clindamycin monotherapy, clindamycin plus MSSA coverage (eg, nafcillin), or clindamycin plus MRSA coverage (eg, vancomycin) were included. The primary outcome was hospital length of stay (LOS); secondary outcomes were treatment failure and cost. Generalized linear mixed-effects models were used to compare outcomes among antibiotic groups. Of 1,259 children included, 828 children received the most common antistaphylococcal antibiotic regimens: clindamycin monotherapy (47%), clindamycin plus MSSA coverage (33%), and clindamycin plus MRSA coverage (20%). Children receiving clindamycin plus MRSA coverage had higher illness severity (44%) compared with clindamycin monotherapy (28%) and clindamycin plus MSSA (32%) (P =.001). In adjusted analyses, LOS and treatment failure did not differ among the 3 regimens (P =.42 and P =.26, respectively). Cost was significantly lower for children receiving clindamycin monotherapy and highest in those receiving clindamycin plus MRSA coverage (mean, $4,839 vs $5,348, respectively; P <.001). In children with SSSS, the addition of MSSA or MRSA coverage to clindamycin monotherapy was associated with increased cost and no incremental difference in clinical outcomes.
Sections du résumé
BACKGROUND
Controversy exists regarding the optimal antibiotic regimen for use in hospitalized children with staphylococcal scalded skin syndrome (SSSS). Various regimens may confer toxin suppression and/or additional coverage for methicillin-susceptible Staphylococcus aureus (MSSA) or methicillin-resistant S aureus (MRSA).
OBJECTIVES
To describe antibiotic regimens in hospitalized children with SSSS and examine the association between antistaphylococcal antibiotic regimens and patient outcomes.
DESIGN/METHODS
Retrospective cohort study of children hospitalized with SSSS using the Pediatric Health Information System database (2011-2016). Children who received clindamycin monotherapy, clindamycin plus MSSA coverage (eg, nafcillin), or clindamycin plus MRSA coverage (eg, vancomycin) were included. The primary outcome was hospital length of stay (LOS); secondary outcomes were treatment failure and cost. Generalized linear mixed-effects models were used to compare outcomes among antibiotic groups.
RESULTS
Of 1,259 children included, 828 children received the most common antistaphylococcal antibiotic regimens: clindamycin monotherapy (47%), clindamycin plus MSSA coverage (33%), and clindamycin plus MRSA coverage (20%). Children receiving clindamycin plus MRSA coverage had higher illness severity (44%) compared with clindamycin monotherapy (28%) and clindamycin plus MSSA (32%) (P =.001). In adjusted analyses, LOS and treatment failure did not differ among the 3 regimens (P =.42 and P =.26, respectively). Cost was significantly lower for children receiving clindamycin monotherapy and highest in those receiving clindamycin plus MRSA coverage (mean, $4,839 vs $5,348, respectively; P <.001).
CONCLUSIONS
In children with SSSS, the addition of MSSA or MRSA coverage to clindamycin monotherapy was associated with increased cost and no incremental difference in clinical outcomes.
Identifiants
pubmed: 33617441
pii: jhm.3529
doi: 10.12788/jhm.3529
pmc: PMC7929614
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
149-155Subventions
Organisme : AHRQ HHS
ID : K08 HS026006
Pays : United States
Organisme : NIH HHS
ID : UG1 OD024953
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Références
Emerg Infect Dis. 2008 May;14(5):720-6
pubmed: 18439352
J Med Case Rep. 2018 Jan 29;12(1):20
pubmed: 29378637
Infect Control Hosp Epidemiol. 2013 Dec;34(12):1244-51
pubmed: 24225608
Pediatr Ann. 2010 Oct;39(10):627-33
pubmed: 20954609
J Clin Microbiol. 2006 Jun;44(6):2119-25
pubmed: 16757607
Pediatr Dermatol. 2014 May-Jun;31(3):305-8
pubmed: 24033633
Pediatrics. 2011 Sep;128(3):e479-87
pubmed: 21844058
JAMA. 2008 May 7;299(17):2048-55
pubmed: 18460665
Clin Infect Dis. 2018 Apr 17;66(9):1470-1474
pubmed: 29293890
Clin Infect Dis. 2004 Mar 15;38(6):864-70
pubmed: 14999632
AJP Rep. 2017 Apr;7(2):e134-e137
pubmed: 28674637
BMC Pediatr. 2014 Aug 08;14:199
pubmed: 25102958
Br J Dermatol. 2018 Mar;178(3):704-708
pubmed: 29077993
Acta Paediatr. 2015 Jun;104(6):566-74
pubmed: 25655941
Hosp Pediatr. 2019 Jan;9(1):30-38
pubmed: 30578271
J Eur Acad Dermatol Venereol. 2014 Nov;28(11):1418-23
pubmed: 24841497
Clin Microbiol Rev. 1999 Apr;12(2):224-42
pubmed: 10194458
Pediatrics. 2004 Oct;114(4):965-9
pubmed: 15466092
J Am Acad Dermatol. 2018 Feb;78(2):404-406
pubmed: 29332709
Pediatr Dermatol. 2014 Jan-Feb;31(1):43-7
pubmed: 23557104
Clin Microbiol Rev. 2017 Oct;30(4):887-917
pubmed: 28724662
Pediatr Infect Dis J. 2000 Sep;19(9):819-21
pubmed: 11001102
Hosp Pediatr. 2018 Sep;8(9):530-537
pubmed: 30139766
J Infect Dis. 2002 May 15;185(10):1511-6
pubmed: 11992289
Pediatr Infect Dis J. 2020 Jan;39(1):30-34
pubmed: 31725120
Pediatr Infect Dis J. 2003 Mar;22(3):284-6
pubmed: 12664881