TY - JOUR
T1 - Antibiotic Regimens and Associated Outcomes in Children Hospitalized With Staphylococcal Scalded Skin Syndrome
AU - Neubauer, Hannah C.
AU - Hall, Matthew
AU - Lopez, Michelle A.
AU - Cruz, Andrea T.
AU - Queen, Mary Ann
AU - Foradori, Dana M.
AU - Aronson, Paul L.
AU - Markham, Jessica L.
AU - Nead, Jennifer A.
AU - Hester, Gabrielle Z.
AU - McCulloh, Russell J.
AU - Wallace, Sowdhamini S.
N1 - Funding Information:
Funding: Dr McCulloh receives support from the Office of the Director of the National Institutes of Health (NIH) under award UG1OD024953. Dr Aronson is supported by grant number K08HS026006 from the Agency for Healthcare Research and Quality (AHRQ). Funded by the NIH. The content is solely the responsibility of the authors and does not represent the official views of AHRQ or the NIH. Drs Neubauer, Hall, Cruz, Queen, Foradori, Markham, Nead, and Hester report no relevant financial or nonfinancial relationships or support.
Funding Information:
In this large, multicenter cohort of hospitalized children with SSSS, we found that the addition of MSSA or MRSA coverage to clindamycin monotherapy was not associated with differences in outcomes of hospital LOS and treatment failure. Furthermore, clindamycin monotherapy was associated with lower overall cost. Prospective randomized studies are needed to confirm these findings and assess whether clindamycin monotherapy, monotherapy with an anti-MSSA antibiotic, or alternative regimens are most effective for treatment of children with SSSS. Disclosures: Drs Wallace and Lopez are site investigators for a phase 2 clinical trial for a novel antibiotic, ceftolozane/tazobactam, sponsored by Merck Sharp & Dohme Corp. Dr McCulloh from time to time provides expert consultation on medical matters. Funding: Dr McCulloh receives support from the Office of the Director of the National Institutes of Health (NIH) under award UG1OD024953. Dr Aronson is supported by grant number K08HS026006 from the Agency for Healthcare Research and Quality (AHRQ). Funded by the NIH. The content is solely the responsibility of the authors and does not represent the official views of AHRQ or the NIH. Drs Neubauer, Hall, Cruz, Queen, Foradori, Markham, Nead, and Hester report no relevant financial or nonfinancial relationships or support.
Publisher Copyright:
© 2021 Society of Hospital Medicine.
PY - 2021/3
Y1 - 2021/3
N2 - 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.
AB - 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.
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U2 - 10.12788/jhm.3529
DO - 10.12788/jhm.3529
M3 - Article
C2 - 33617441
AN - SCOPUS:85102603111
SN - 1553-5592
VL - 16
SP - 149
EP - 155
JO - Journal of hospital medicine
JF - Journal of hospital medicine
IS - 3
ER -