Toxic shock syndrome in Australian children.
BACKGROUND
There are limited data describing the epidemiology, management and outcomes of children with toxic shock syndrome (TSS), a potentially life-threatening illness. Here, we describe the incidence, clinical features, treatment and outcome of children with staphylococcal and streptococcal TSS in Victoria, Australia.


METHODS
Retrospective chart review of children admitted between 2003 and 2014 to two tertiary paediatric referral centres who fulfilled the Centers for Disease Control and Prevention case definition of TSS.


RESULTS
There were 62 cases over the 11-year period; 43 staphylococcal TSS and 19 streptococcal TSS. The majority (46 (74%)) of cases were admitted to an intensive care unit and 44 (71%) required inotropic support. Compared with those with staphylococcal TSS, patients with streptococcal TSS were younger, more unwell and more likely to have residual morbidity. Adjunctive therapy with intravenous immunoglobulin or clindamycin was used in 58 (94%) of cases and fresh frozen plasma was used in 15 (24%). Seven patients received extracorporeal membrane oxygenation. All patients survived.


CONCLUSIONS
This study highlights the importance of early recognition of TSS and supports rapid tertiary referral and intensive care management, which includes the use of adjunctive therapy with intravenous immunoglobulin and clindamycin.
Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Australia Department of Paediatrics, The University of Melbourne, Parkville, Australia Infectious Diseases Unit and Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia.
Katherine Y H
http://orcid.org/0000-0003-3301-8031
KY
Chen
Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Australia Department of Paediatrics, The University of Melbourne, Parkville, Australia Department of Cardiology, The Royal Children's Hospital Melbourne, Parkville, Australia.
Michael
M
Cheung
Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Australia Department of Paediatrics, The University of Melbourne, Parkville, Australia Department of Paediatrics, Monash University, Clayton, Australia.
David P
DP
Burgner
Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Australia Department of Paediatrics, The University of Melbourne, Parkville, Australia Infectious Diseases Unit and Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia.
Nigel
N
Curtis
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use; D003422:Critical Care; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D012772:Shock, Septic / Q000175:diagnosis / Q000453:epidemiology*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology*; D013211:Staphylococcus aureus; D013290:Streptococcal Infections / Q000188:drug therapy / Q000453:epidemiology*; D013297:Streptococcus pyogenes; D016896:Treatment Outcome; D014739:Victoria / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D016756:Immunoglobulins, Intravenous; D002981:Clindamycin
General Paediatrics; Infectious Diseases