467. Antimicrobial Resistance and Molecular Analysis of Staphylococcus aureus in Staphylococcal Scalded Skin Syndrome among Children in Korea

Abstract

Abstract Background Staphylococcal scalded skin syndrome (SSSS) is a blistering and desquamative skin disease caused by the exfoliative toxins of Staphylococcus aureus. SSSS mainly affects children younger than 5 years of age. Although many countries show a predominance of methicillin-susceptible S. aureus (MSSA), recently an increase in cases due to methicillin-resistant S. aureus (MRSA) has been reported. We investigated the molecular characteristics of S. aureus isolated from the children with SSSS in Korea. Methods From January 2010 to December 2017, children clinically diagnosed as SSSS under the age of 5 years were enrolled. Cases from 3 different university hospitals in Korea were included. S. aureus isolated from nasal, axillary, or inguinal area of the children were analyzed for multilocus sequence type and exfoliative toxins (eta, etb). Medical records were retrospectively reviewed for clinical characteristics and antimicrobial susceptibility patterns of S. aureus. Results A total of 26 cases were enrolled. The mean age was 2.3 years (range, 0–4.8 years). Twenty-two (84.6%) patients were hospitalized. Skin manifestations were classified as follows; generalized (n = 10, 38.5%), intermediate (n = 11, 42.3%), and abortive (n = 5, 19.2%). Twenty-five isolates (96.2%) were resistant to methicillin and macrolide-resistance was found in 92.3% (n = 24). ST89 (n = 21, 80.8%) was the most prevalent clone, with single clones of ST1, ST5, ST72, ST121, and ST1507. The eta gene was detected in 1 (3.8%) MSSA isolate. The etb gene was detected in 14 (53.8%) isolates all of which were ST89. All patients were treated with antibiotics, and the mean duration was 8.3 days regardless of the administration route. Nafcillin or first cephalosporin was most commonly prescribed (n = 20, 76.9%), clindamycin was administered in combination in 9 patients (34.6%) and vancomycin in 4 patients (15.4%). Among the 25 MRSA cases, only 6 (24.0%) were treated with susceptible antibiotics. However, there was no difference in treatment duration according to antimicrobial susceptibility (8.43:8.22 days, P > 0.05). Conclusion The molecular epidemiology of S. aureus isolated from the Korean children with SSSS demonstrated the high prevalence of methicillin-resistant ST89 clone that harbors the etb gene. Disclosures All authors: No reported disclosures.