Retrospective Analysis Of 199 Patients With Staphylococcal Scalded Skin Syndrome

Objective: to know predisposing factors, clinical manifestations, drug allergy, treatment and therapy and prognosis of staphylococcal scalded skin syndrome.Methods: clinical data of child patients with SSSS who were diagnosed by the affiliate hospital of Zunyi medical college from January 2015 to December 2015 were collected for statistic analysis with SPSSl6.0 software, t test and rank sum test. α=0.05 served as the inspection standard.Results:1. General condition: the male-female ratio among 199 child patients was 1.2:1. Their age range was 15 days old ~10 years old, and the average age of onset was 2 years old to 4 months old. The age was mainly distributed in the infant period and pre-school age period. The diseases mainly happened in summer, autumn and winter. The urban-rural ratio was 1:4.2. Misdiagnosis: only 5 child patients with SSSS were diagnosed by local hospitals, and 57 cases were misdiagnosed with eczematous dermatitis or other skin diseases. The diagnosis of remaining 137 cases was not clear.3. Clinical features: all child patients were accompanied by diffuse flake-like erythema. Nikolsky sign of 33 cases was positive. 76 cases were accompanied by slack blister and pustule. There were 138 cases with typical radial plica around the mouth. 88 cases fevered, and most of them suffered from low-grade fever. The remaining 11 cases had normal temperature.4.Laboratory examination: WBC of 118 cases rose. HB of some child patients decreased, and their PC, electrolyte, hepatic and renal functions were slightly a bnormal. There are 24 in 30 chlidren whose myocardial enzyme examination r ose in different degrees. 5.Drug allergy test: among 154 cases, staphylococcus aureus was found throughbacterial culture in the excreta of wound surface of 88 cases, and their drug sensitivity rate was as follows: levofloxacin 97.7%, quinupristin/ dalfopristin 98.9%, ciprofloxacin 96.6%, erythrocin 4.5%, gentamicin 95.5%, oxacillin 56.8%, penicillin 0%, rifampicin 58.0%, SMZ-TMP 55.7%, tetracycline 77.3%, lincomycin 10.2%, benzathine benzylpenicillin 96.6%, amoxicillin 82.8%, chloramphenicol 89.7%, clindamycin 3.4%, cefazolin 82.8%, imipenem 82.8%, piperacillin 93.1%; imezolid, vancomycin, macrodantin, linezolid, tigecycline and moxifloxacin 100%. Among 28 child patients, staphylococcus aureus was found in only 1 child patient through bacterial culture. Except penicillin, erythrocin and tetracycline, the child patients were sensitive to all the drugs above.6.Treatment: the antibiotics applied mainly included semisynthetic penicillin, cephalosporin, clindamycin and fosfomycin. Rash disappearance time was used as the index to analyze the above four groups, and there was no difference in the results. When the hospitalization duration was used as the index, the hospitalization duration group showed better effect than the group of semisynthetic penicillin, while there was no difference for other groups. The first-generation cephalosporin group, second-generation cephalosporin group and third-generation cephalosporin group had no difference when they were compared with the index of hospitalization duration. When rash disappearance time was used as the index, second-generation cephalosporin group showed better effect than third-generation cephalosporin group. Statistical analysis was made for whether to apply glucocorticoid by taking hospitalization duration and rash disappearance time as the indexes. The result shows there was no difference.7.Prognosis: among 199 child patients, 11 cases signed and left hospital, and the remaining cases improved or cured. The hospitalization duration was 14-17 days, and the average hospitalization duration was 8-9 days. There was no death case.Conclusion:(1) SSSS mainly occurs to infants and children at pre-school age. It is happened mostly in summer, autumn and winter. It is more common in rural areas than urban areas. The induction factor is upper respiratory infection and skin injury etc.(2) The child patients with SSSS are easily misdiagnosed in primary hospitals, so primary doctors should enhance cognition of this disease.(3) Antibiotics should be applied early and fully.The second generation of cephalosporin has good effect.(4) In the bacterial culture test, the excreta on the wound surface is suggested for bacterial culture. Myocardial enzyme can be used as normal inspection. The drugs protecting myocardium can be used according to the inspection result.