title: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Dermatology, Paracelsus Private Medical University of Salzburg, Salzburg, Austria. m.emberger@aon.at
authors.forename: M
authors.initials: M
authors.lastname: Emberger
authors.forename: J
authors.initials: J
authors.lastname: Koller
authors.forename: M
authors.initials: M
authors.lastname: Laimer
authors.forename: M
authors.initials: M
authors.lastname: Hell
authors.forename: K
authors.initials: K
authors.lastname: Oender
authors.forename: A
authors.initials: A
authors.lastname: Trost
authors.forename: M
authors.initials: M
authors.lastname: Maass
authors.forename: W
authors.initials: W
authors.lastname: Witte
authors.forename: H
authors.initials: H
authors.lastname: Hintner
authors.forename: A M
authors.initials: AM
authors.lastname: Lechner
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000635:transmission*; D005260:Female; D006801:Humans; D006920:Hygiene / Q000592:standards; D007270:Injections, Intra-Articular / Q000009:adverse effects*; D008297:Male; D009297:Nasal Mucosa / Q000382:microbiology; D010003:Osteoarthritis / Q000188:drug therapy; D012307:Risk Factors; D012867:Skin / Q000382:microbiology; D013206:Staphylococcal Scalded Skin Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000635:transmission*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents