{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T15:48:55Z","timestamp":1785944935211,"version":"3.56.0"},"reference-count":17,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T00:00:00Z","timestamp":1697068800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Hunan Provincial Science and Technology Innovation Program Funding Project","award":["2020SK50508"],"award-info":[{"award-number":["2020SK50508"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Streptococcal toxic shock syndrome (STSS) is a severe consequence of infections from Streptococcus pyogenes. The early identification and timely intervention with appropriate anti-infective agents are pivotal for managing pediatric STSS. This study evaluates the effectiveness of various treatment regimens for STSS in children.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Clinical data of children with STSS resulting from \u03b2-hemolytic streptococcal infections in two hospitals were retrospectively analyzed from January 2009 to April 2023. Additionally, literature from the China National Knowledge Infrastructure on pediatric STSS was examined. Antimicrobial treatments were categorized into four groups based on their compositions, with an additional categorization for adjunct therapeutic drugs.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of 32 confirmed STSS cases, all displayed sensitivity to ampicillin, \u03b2-lactam antibiotics, and vancomycin, but resistance to clindamycin, erythromycin, and tetracycline. From the literature, 23 studies with 50 cases were extracted, leading to a total of 82 patients for evaluation. The efficacy rates varied significantly among the four treatment groups. Notably, the standard penicillin-containing group exhibited the highest efficacy (86.4%), while the group with macrolides\/unused antibiotics registered a 0% efficacy rate. The other two groups demonstrated efficacy rates of 32.1% and 42.3%.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>For pediatric STSS, Streptococcus pyogenes shows notable sensitivity to ampicillin. Implementing timely \u03b2-lactam antibiotics, specifically penicillin, in conjunction with clindamycin and intravenous immunoglobulins enhances the treatment success rate.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0292311","type":"journal-article","created":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T17:34:55Z","timestamp":1697132095000},"page":"e0292311","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Evaluating antibiotic regimens for streptococcal toxic shock syndrome in children"],"prefix":"10.1371","volume":"18","author":[{"given":"Haixia","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaotian","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keyuan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiulan","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2701-9066","authenticated-orcid":true,"given":"Changqiong","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,10,12]]},"reference":[{"key":"pone.0292311.ref001","first-page":"587","article-title":"Streptococcal toxic shock syndrome caused by Streptococcus pyogenes: a retrospective study of 15 pediatric cases","volume":"56","author":"CZ Hua","year":"2018","journal-title":"Zhonghua Er Ke Za Zhi"},{"key":"pone.0292311.ref002","first-page":"729","article-title":"A case of streptococcal toxic shock syndrome mainly manifesting as multiple ecthyma gangrenosum","volume":"54","author":"WF Lu","year":"2021","journal-title":"Zhonghua Pi Fu Ke Zhi"},{"key":"pone.0292311.ref003","first-page":"306","article-title":"Streptococcal toxic shock syndrome: report of 2 cases","volume":"45","author":"L Dong","year":"2007","journal-title":"Zhonghua Er Ke Za Zhi"},{"key":"pone.0292311.ref004","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1001\/jama.1993.03500030088038","article-title":"Defining the group A streptococcal toxic shock syndrome. Rationale and consensus definition","volume":"269","author":"The working group on severe streptococcal infections","year":"1993","journal-title":"JAMA"},{"key":"pone.0292311.ref005","unstructured":"Centers for Disease Control and Prevention. Streptococcal toxic shock syndrome (STSS) (Streptococcus pyogenes). [Cited September 18, 2018]. https:\/\/ndc.services.cdc.gov\/conditions\/streptococcal-toxic-shock-syndrome\/."},{"key":"pone.0292311.ref006","unstructured":"CLSI performance standards for antimicrobial susceptibility testing. EDN. Wayne, Pennsylvania: Clinical and Laboratory Standards Institute; 2022, Volume M100. 32st."},{"key":"pone.0292311.ref007","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1093\/cid\/ciy401","article-title":"Polyspecific intravenous immunoglobulin in clindamycin-treated patients with streptococcal toxic shock syndrome: A systematic review and meta-analysis","volume":"67","author":"T Parks","year":"2018","journal-title":"Clin Infect Dis"},{"key":"pone.0292311.ref008","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1016\/j.jemermed.2017.12.048","article-title":"The evaluation and management of toxic shock syndrome in the emergency department: a review of the literature","volume":"54","author":"M Gottlieb","year":"2018","journal-title":"J Emerg Med"},{"key":"pone.0292311.ref009","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/j.idc.2022.07.007","article-title":"ICU management of invasive \u03b2-hemolytic streptococcal infections","volume":"36","author":"A Babiker","year":"2022","journal-title":"Infect Dis Clin North Am"},{"key":"pone.0292311.ref010","doi-asserted-by":"crossref","unstructured":"Group A streptococcal infections. Red. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, editors. Report of the Committee on Infectious Diseases, 30th, Book 2015. Elk Grove Village, Illinois: American Academy of Pediatrics; 2015. p. 732.","DOI":"10.1542\/9781581109276-Group"},{"key":"pone.0292311.ref011","first-page":"E000142","article-title":"Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions [J]","volume":"10","author":"M Cumpston","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0292311.ref012","first-page":"844","article-title":"Technical guidelines for clinical trials of antimicrobial drugs","volume":"30","author":"Technical guidelines for clinical trials of antimicrobial drugs writing group","year":"2014","journal-title":"Chin J Clin Pharmacol"},{"key":"pone.0292311.ref013","doi-asserted-by":"crossref","first-page":"e122","DOI":"10.1097\/INF.0000000000003810","article-title":"Increase in invasive group a streptococcal infections in children in the Netherlands, A survey among 7 hospitals in 2022","volume":"42","author":"EB van Kempen","year":"2023","journal-title":"Pediatr Infect Dis J"},{"key":"pone.0292311.ref014","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.3201\/eid2809.212129","article-title":"Increasing incidence of invasive Group A streptococcus disease, Idaho, USA, 2008\u20132019","volume":"28","author":"EM Dunne","year":"2022","journal-title":"Emerg Infect Dis"},{"key":"pone.0292311.ref015","doi-asserted-by":"crossref","first-page":"e2","DOI":"10.1016\/S2352-4642(22)00374-1","article-title":"Paediatric group A streptococcal disease in England from October to December, 2022","volume":"7","author":"SN Ladhani","year":"2023","journal-title":"Lancet Child Adolesc Health"},{"key":"pone.0292311.ref016","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.2147\/IDR.S261975","article-title":"Is there emergence of \u03b2-lactam antibiotic-resistant Streptococcus pyogenes in China?","volume":"13","author":"D Yu","year":"2020","journal-title":"Infect Drug Resist"},{"key":"pone.0292311.ref017","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.jgar.2022.05.012","article-title":"Prevalence and identification of antibiotic-resistant scarlet fever group A Streptococcus strains in some paediatric cases at Shenzhen, China","volume":"30","author":"L Sun","year":"2022","journal-title":"J Glob Antimicrob Resist"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0292311","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T17:35:07Z","timestamp":1697132107000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0292311"}},"subtitle":[],"editor":[{"given":"Gul","family":"Ambreen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,10,12]]},"references-count":17,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0292311","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,12]]}}}