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Information Technology and Surveillance

Category: Information Technology and Surveillance

ePoster Kiosk Presentation

ITS 98 - Outbreak Investigation of Staphylococcal Scalded Skin Syndrome in the Neonatal Intensive Care Unit Using Whole Genome Sequencing

Monday, June 3, 2024
11:46 AM – 12:15 PM CST
Location: Kiosk 6 - APIC Central, Hall 1
Disclosure(s):
Tamika N. Anderson, MT (ASCP)cm, MPH, CIC: No financial relationships to disclose
Mamta Sharma, MD, FACP, FIDSA, FSHEA: No financial relationships to disclose
Athina Pappas, MD: No financial relationships to disclose
Muthayipalayam C. Thirumoorthi, MD: No financial relationships to disclose
Rand Farjo, MD: No financial relationships to disclose
Lisa K. Sturm, MPH, CIC, FAPIC: No financial relationships to disclose
Nicole Nomides, MT(ASCP), MS, CIC, FAPIC: No financial relationships to disclose


Background: Staphylococcal scalded skin syndrome (SSSS) is a blistering skin condition caused by exfoliative toxin-producing strains of Staphylococcus aureus (S. aureus). It is a dermatological emergency that requires hospitalization and prompt treatment. We describe a methicillin- susceptible S. aureus (MSSA) staphylococcal scalded skin syndrome outbreak in the neonatal intensive care unit (NICU) and the measures taken to stop the outbreak

Methods: A point prevalence screening was performed between March 13, 2023 and May 8, 2023 after identification of a case of SSSS. The screening was performed weekly and on admission. Swabs were collected from the anterior nares in the majority of cases. Isolates with the same antibiogram were sent out for whole genome sequencing. Screening was performed until no new MSSA cases with identical antibiogram was identified. Infection prevention collaboration conference calls were held weekly to evaluate the effectiveness of infection control measures.

Results: 261 patients were screened for S. aureus. 20 patients (7.7%) tested positive for MSSA. 3 patients (including the index patient) were identified as having SSSS. Whole genomic sequencing was performed in 21 patients. Eleven known sequence types (ST) were detected. ST2276, ST8, ST398 and ST45 showed strong genomic linkage, with ST2276 identified as the original strain for transmission. One novel sequence belonged to ST8; this isolate was not genetically linked with the previous sequence. Two isolates were classified as unknown.

Conclusions: Transmission of SSSS can occur in the NICU. Infection control measures to prevent transmission include environmental cleaning, hand hygiene, avoiding overcrowding, and isolation of positive patients in addition to decolonization with nasal mupirocin and chlorhexidine baths per gestation age. Whole-genome sequencing analysis are invaluable tools for epidemic investigation. When applying to surveillance and investigation in the clinical setting, this approach may provide measures for appropriate, and effective interventions

Learning Objectives:

  • identify gaps to determine the cause of an outbreak.
  • implement infection control measures to limit and curb transmission of an outbreak.
  • utilize genomic sequencing to identify transmission of diseases in outbreak investigations.