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Staphylococcal scalded skin syndrome — RACP Paediatrics MCQ

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HardNeonatalStaphylococcal scalded skin syndromeRACP Paediatrics

A febrile 8-day-old has diffuse tender erythema, superficial flaccid bullae and a positive Nikolsky sign. Mucous membranes are spared. The local unit has substantial community MRSA prevalence. Which initial antimicrobial approach is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Admit for intravenous anti-staphylococcal therapy covering local MRSA risk

Explanation lettering: E = shown as A · A = shown as B · B = shown as C · C = shown as E

C is correct. This is SSSS; the neonate requires admission, fluid/skin care and intravenous anti-staphylococcal treatment, with MRSA-active therapy selected when local epidemiology makes it plausible. A and B under-treat systemic toxin-mediated disease. D neonatal HSV remains an important differential but aciclovir alone does not cover this presentation. E immunosuppression worsens infection and does not neutralise toxin.

Reference: RCH Melbourne, Cellulitis and other bacterial skin infections: https://www.rch.org.au/clinicalguide/guideline_index/Cellulitis_and_skin_infections/