2026 Southeastern Residency Conference

Background: Staphylococcal scalded skin syndrome (SSSS) is a serious toxin-mediated dermatologic condition that primarily affects young children and is an important cause of pediatric hospitalization. This syndrome is caused by exfoliative toxins produced by Staphylococcus aureus, resulting in diffuse erythema, skin fragility, and superficial blistering with subsequent desquamation. Current management focuses on eradication of the toxin-producing organism with systemic antistaphylococcal antibiotics in conjunction with supportive care. Beta-lactam antibiotics with activity against methicillin-susceptible S. aureus, such as nafcillin, are considered first-line therapy. Clindamycin is frequently used as adjunctive therapy due to its ability to inhibit bacterial protein synthesis and suppress toxin production. However, the addition of clindamycin for antitoxin use in SSSS has remained controversial with conflicting findings in primary literature of whether it should be added to mainstay treatment. This study evaluates the association between adjunctive clindamycin use in combination with nafcillin and length of stay (LOS) in pediatric patients with SSSS at our institution. Methods: A single-center, institutional review committee (IRC)–approved retrospective analysis was conducted at Huntsville Hospital for Women and Children to evaluate nafcillin monotherapy compared to the combination of nafcillin and clindamycin in relation to LOS of patients admitted between January 1, 2019 and August 31, 2025. Pediatric patients ages one month to 18 years that received at least one dose of nafcillin and with an ICD-10 code L00 for SSSS were included in the analysis. Patients with alternate diagnoses, concomitant infections requiring broader-spectrum antibiotics, or transferred out of the facility due to needing a higher level of care were excluded. The primary outcome was hospital LOS between the two groups. Secondary outcomes included the utilization of adjunctive and supportive medications during hospitalization, specifically the use of scheduled pain medications, scheduled antipruritic medications, as-needed (PRN) pain medications, and PRN antipruritic medications. Continuous variables were summarized using means with standard deviations and medians with interquartile ranges (IQR). Categorical variables were reported as percentages. Analysis for statistical significance was computed using RStudio ®.Results: Eighty-five patients were included in the evaluation of the primary and secondary endpoints. 18 patients were treated with nafcillin monotherapy and 67 were treated with the combination of nafcillin and clindamycin. Mean LOS was 3.89 ± 1.78 days in the nafcillin group and 3.70 ± 1.66 days in the combination group, corresponding to a mean difference of −0.19 days (95% CI −1.10 to 0.69; p = 0.78). Median LOS was 3.5 days (IQR 3.0–4.8) for nafcillin monotherapy and 4.0 days (IQR 3.0–4.0) for combination therapy (Hodges–Lehmann shift 0 days; 95% CI −1 to 1; p = 0.78). No secondary outcomes were statistically significant after adjustment for multiple comparisons. Local microbiologic data demonstrated low clindamycin resistance among MSSA isolates (10%) and overall low prevalence of MRSA isolates (7.4%).Conclusion: The combination of nafcillin and clindamycin use was not associated with a statistically significant reduction in hospital LOS among pediatric patients with SSSS. These findings align with prior literature suggesting limited impact of clindamycin on hospitalization duration1, 2. Additionally, no statistically significant differences were observed in the secondary outcomes evaluating the utilization of scheduled or as-needed medications. Routine adjunctive clindamycin use for LOS reduction in pediatric SSSS is not supported by this data and should be considered within the context of institutional susceptibility patterns and antimicrobial stewardship principles.