葡萄球菌烫伤样皮肤综合征177例临床分析

Clinical analysis of 177 cases of staphylococcal scalded skin syndrome

目的 探讨177例葡萄球菌烫伤样皮肤综合征（SSSS）患儿的诊断和治疗。方法 回顾性研究177例SSSS患儿的临床资料。探讨其年龄和地区分布、发病诱因、临床特征、详细的实验室检查、病原菌分离培养和药敏、治疗方法以及预后情况。结果 本组共177例，发病年龄中位数约为1岁3个月23天，多见于婴幼儿期，男女性别比约为8 ∶ 9，71.2%于夏秋季节患病。患儿多来自农村，148例（83.6%）无明确的发病诱因，多起病于颜面部（71.6%）。129例检查心肌酶谱104例（80.6%）异常，142例中38.7%分离出金黄色葡萄球菌。对近3年金黄色葡萄球菌药敏试验结果分析显示，头孢菌素类和阿莫西林/棒酸的敏感率分别为95.2%和95.0%。72.9%双联抗生素治疗有效，36.2%患儿早期予以丙种球蛋白，对于心肌酶异常患儿早期给予保护心肌药物，所有患儿痊愈且不留瘢痕。结论 对于出现颜面部的急性红斑和表皮脱屑的婴幼儿应高度怀疑为SSSS，且予以及时的抗生素治疗，头孢菌素类和半合成青霉素复合制剂应是首选有效的药物，同时早期合用丙种球蛋白和保护心肌药物有利于疾病恢复。

Objective To assess the diagnosis and treatment of staphylococcal scalded skin syndrome （SSSS）in children. Methods A total of 177 children with SSSS were eligible for this study. Clinical data were retrospectively reviewed to assess the patients′ age and geographical areas, predisposing factors, prodrome, clinical features, results of laboratory examination （including bacterial isolation and drug susceptibility test）, treatment and prognosis. Results The median age at onset was 23 days past 15 months. Infants aged 1 to 3 years were the most commonly affected population. The male to female ratio was 8：9. SSSS occurred in summer or autumn in 71.2% of the patients. Most patients came from countryside. Of these patients, 148（83.6%） had no definite inducement, 13 （7.3%） had fever or cold history before the occurrence of SSSS. Skin lesions often began in the face （71.6%）. Almost all cases presented with erythema and blisters. Abnormal myocardial enzymes were observed in 104 （80.6%） of 129 patients, and Staphylococcus aureus was isolated from 38.7% of 142 patients. Susceptibility testing of 21 Staphylococcus aureus isolates from patients in the past 3 years showed that 95.2% and 95.0% were sensitive to cephalosporins and amoxicillin/clavulanic acid respectively. Double-antibiotic therapy was effective in 72.9% of the patients. Intravenous gamma globulin was given to 36.2% of the patients in the early stage. Myocardial-protecting drugs were also administrated early in patients with abnormal myocardial enzymes. All the patients healed without scarring. Conclusions For infants with acute facial erythema and exfoliative skin lesions, SSSS should be suspected and timely antibiotic treatment should be given. Cephalosporins and semi-synthetic penicillins are effective and the first choice for the treatment of SSSS. Meanwhile, early addition of gamma globulin and myocardial-protecting drugs may be beneficial to disease recovery.