Nosocomial Staphylococcal scalded skin syndrome caused by intra-articular injection.

Abstract

BACKGROUND:

The pathogenic role of nasal carriage as a source for cutaneous and soft-tissue Staphylococcus aureus (SA) infections, and Staphylococcal scalded skin syndrome (SSSS) in particular, is unclear.

OBSERVATION:

We herein describe a nosocomial outbreak of SSSS in three orthopaedic patients who received intra-articular injections by a single orthopaedic surgeon. Bacteriological samples from the index patients and medical personnel involved in their care were assessed by phage typing, polymerase chain reaction for exfoliative toxin genes, SmaI macro-restriction analysis and molecular spa-typing. These studies first revealed SA cultural growth in synovial fluid of all three patients as well as nasal mucosa of one medical assistant. Moreover, all SA isolates had the same phage typing and antibiotic susceptibilities and were positive for exfoliative toxin ETa by polymerase chain reaction. SmaI macro-restriction and spa-typing further confirmed all proband isolates to be identical.

CONCLUSION:

These findings provide evidence that SA nasal colonization of otherwise healthy carriers is a risk factor for SA infections, including SSSS, in predisposed individuals.

• Authors: M Emberger, J Koller, M Laimer, M Hell, K Oender, A Trost, M Maass, W Witte, H Hintner, A M Lechner
• Journal: Journal of the European Academy of Dermatology and Venereology : JEADV (J Eur Acad Dermatol Venereol) Vol. 25 Issue 2 Pg. 227-31 (Feb 2011) ISSN: 1468-3083 [Electronic] England
• PMID: 20579227 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2010 The Authors. Journal of the European Academy of Dermatology and Venereology © 2010 European Academy of Dermatology and Venereology.

Chemical References

• Adrenal Cortex Hormones
• Anti-Bacterial Agents

Topics

• Adrenal Cortex Hormones (administration & dosage, therapeutic use)
• Aged
• Anti-Bacterial Agents (therapeutic use)
• Cross Infection (diagnosis, drug therapy, transmission)
• Female
• Humans
• Hygiene (standards)
• Injections, Intra-Articular (adverse effects)
• Male
• Nasal Mucosa (microbiology)
• Osteoarthritis (drug therapy)
• Risk Factors
• Skin (microbiology)
• Staphylococcal Scalded Skin Syndrome (diagnosis, drug therapy, transmission)
• Staphylococcus aureus (isolation & purification)
• Treatment Outcome