{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T10:38:43Z","timestamp":1781174323337,"version":"3.54.1"},"reference-count":27,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Staphylococcal scalded skin syndrome (SSSS) is a rare, toxin-mediated dermatosis caused by exfoliative toxin\u2013producing Staphylococcus aureus strains, with neonates and preterm infants being particularly vulnerable due to immature immunity and reduced toxin clearance. We report the case of a male preterm infant, born at 24 weeks of gestation, who presented at the age of one month with fever and later developed widespread erythema, flaccid bullae, and periorificial desquamation. Methicillin-sensitive S. aureus (MSSA) was isolated from blood, catheter, and auricular swabs. Whole-genome sequencing revealed sequence type ST121 carrying both eta and etb genes, confirming the dual-toxin profile associated with severe disease. The infant improved with targeted intravenous oxacillin following catheter removal. A subsequent nasal swab identified a methicillin-resistant S. aureus (MRSA) ST30 strain lacking exfoliative toxins, consistent with asymptomatic colonization. This case underscores the importance of integrating advanced molecular diagnostics such as next-generation sequencing into the management of neonatal SSSS, enabling precise identification of virulence factors and resistance genes. Literature also highlights the global epidemiology of SSSS, diversity of S. aureus toxin genes, and value of genomic surveillance in neonatal care; our case aligns with reports of ST121 strains carrying both ETA and ETB, where the dual-toxin profile drives rapid onset, extensive skin disease, and good outcomes with prompt therapy.<\/jats:p>","DOI":"10.3390\/antibiotics14101017","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:13:27Z","timestamp":1760361207000},"page":"1017","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Staphylococcal Scalded Skin Syndrome (SSSS) in a Preterm Infant: Clinical Presentation and Role of Next-Generation Sequencing in Toxin Gene Identification\u2014A Case Report"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3893-6088","authenticated-orcid":false,"given":"Giovanni","family":"Lorenzin","sequence":"first","affiliation":[{"name":"Microbiology and Virology Unit, S. Chiara Hospital, 38122 Trento, Largo Medaglie d\u2019oro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6858-9160","authenticated-orcid":false,"given":"Maddalena","family":"Carlin","sequence":"additional","affiliation":[{"name":"Department of Cellular, Computational and Integrative Biology CIBIO, University of Trento, 38123 Trento, Largo Medaglie d\u2019oro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Scarparo","sequence":"additional","affiliation":[{"name":"Microbiology and Virology Unit, S. Chiara Hospital, 38122 Trento, Largo Medaglie d\u2019oro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariachiara","family":"Cardellini","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, S. Chiara Hospital, 38122 Trento, Largo Medaglie d\u2019oro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Tota","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, S. Chiara Hospital, 38122 Trento, Largo Medaglie d\u2019oro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7789-1118","authenticated-orcid":false,"given":"Aldo","family":"Naselli","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, S. Chiara Hospital, 38122 Trento, Largo Medaglie d\u2019oro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/21505594.2023.2242547","article-title":"Comparative analysis of genomic characteristics, virulence and fitness of community-associated Staphylococcus aureus ST121 clone causing fatal diseases in China and other CA-MRSA clones","volume":"14","author":"Zhou","year":"2023","journal-title":"Virulence"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Azarian, T., Cella, E., Baines, S.L., Shumaker, M.J., Samel, C., Jubair, M., Pegues, D.A., and David, M.Z. (2021). Genomic epidemiology and global population structure of exfoliative toxin A-producing Staphylococcus aureus strains associated with staphylococcal scalded skin syndrome. Front. Microbiol., 12.","DOI":"10.3389\/fmicb.2021.663831"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Nusman, C.M., Blokhuis, C., Pajkrt, D., and Visser, D.H. (2023). Staphylococcal scalded skin syndrome in neonates: Case series and overview of outbreaks. Antibiotics, 12.","DOI":"10.3390\/antibiotics12010038"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1111\/pde.16029","article-title":"Pediatric staphylococcal scalded skin syndrome: A systematic review of the literature to inform work-up and management","volume":"42","author":"Gray","year":"2025","journal-title":"Pediatr. Dermatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1128\/JCM.43.4.1890-1893.2005","article-title":"Clinical manifestations of staphylococcal scalded-skin syndrome depend on serotypes of exfoliative toxins","volume":"43","author":"Yamasaki","year":"2005","journal-title":"J. Clin. Microbiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1111\/jdv.12541","article-title":"Staphylococcal scalded skin syndrome: Diagnosis and management in children and adults","volume":"28","author":"Handler","year":"2014","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"7313","DOI":"10.4076\/1752-1947-3-7313","article-title":"Recurring staphylococcal scalded skin syndrome in a very low birth weight infant: A case report","volume":"3","author":"Duijsters","year":"2009","journal-title":"J. Med. Case Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1159\/000501357","article-title":"Complications of hemodialysis catheter bloodstream infections: Impact of infecting organism","volume":"50","author":"Farrington","year":"2019","journal-title":"Am. J. Nephrol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.clnesp.2023.06.032","article-title":"A multi-national survey of experience and attitudes towards managing catheter-related bloodstream infections for home parenteral nutrition","volume":"57","author":"Joly","year":"2023","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_10","unstructured":"Ruocco, E., Baroni, A., Russo, T., Moscarella, E., and Piccolo, V. (2025). Staphylococcal Scalded Skin Syndrome. Emergency Dermatology, Taylor & Francis\/CRC Press. [2nd ed.]."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.burns.2011.08.005","article-title":"Staphylococcal scalded skin syndrome in the Czech Republic: An epidemiological study","volume":"38","author":"Brychta","year":"2012","journal-title":"Burns"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Satam, H., Joshi, K., Mangrolia, U., Waghoo, S., Zaidi, G., Rawool, S., Thakare, R.P., Banday, S., Mishra, A.K., and Das, G. (2023). Next-generation sequencing technology: Current trends and advancements. Biology, 12.","DOI":"10.3390\/biology12070997"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.jgar.2022.01.001","article-title":"Detection of NDM-1\/5 and OXA-48 co-producing extensively drug-resistant hypervirulent Klebsiella pneumoniae in Northern Italy","volume":"28","author":"Lorenzin","year":"2022","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1007\/s00431-002-1080-z","article-title":"Staphylococcal scalded skin syndrome related to an exfoliative toxin A- and B-producing strain in preterm infants","volume":"161","author":"Plano","year":"2002","journal-title":"Eur. J. Pediatr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"985646","DOI":"10.1155\/2012\/985646","article-title":"IgG placental transfer in healthy and pathological pregnancies","volume":"2012","author":"Palmeira","year":"2012","journal-title":"Clin. Dev. Immunol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Hooper, S.M., Fung, C.M., Torr, C., and Lawrence, S.M. (2025). Case report: Delayed recurrence of staphylococcal scalded skin syndrome in an extremely low birth weight infant. Front. Pediatr., 13.","DOI":"10.3389\/fped.2025.1564633"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"416","DOI":"10.2340\/00015555-0447","article-title":"Staphylococcal scalded skin syndrome as a harbinger of late-onset staphylococcal septicaemia in a premature infant of very low birth weight","volume":"88","author":"Heimann","year":"2008","journal-title":"Acta Derm. Venereol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/INF.0000000000002499","article-title":"Increasing numbers of staphylococcal scalded skin syndrome cases caused by ST121 in Houston, Texas","volume":"39","author":"Kok","year":"2020","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"420","DOI":"10.4103\/jdmimsu.jdmimsu_124_25","article-title":"Case series of neonatal staphylococcal scalded skin syndrome from Western India","volume":"20","author":"Mahajan","year":"2025","journal-title":"J. Datta Meghe Inst. Med. Sci. Univ."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e1015","DOI":"10.1542\/peds.2013-3413","article-title":"MRSA colonization and risk of infection in the neonatal and pediatric ICU: A meta-analysis","volume":"133","author":"Zervou","year":"2014","journal-title":"Pediatrics"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1891\/0730-0832.35.1.8","article-title":"Staphylococcal scalded skin syndrome: A case review","volume":"35","author":"Hennigan","year":"2016","journal-title":"Neonatal Netw."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1111\/pde.12114","article-title":"Staphylococcal scalded skin syndrome in neonates: An 8-year retrospective study in a single institution","volume":"31","author":"Li","year":"2014","journal-title":"Pediatr. Dermatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e8240","DOI":"10.1002\/ccr3.8240","article-title":"Congenital staphylococcal scalded skin syndrome in a preterm infant","volume":"11","author":"Lee","year":"2023","journal-title":"Clin. Case Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1007\/s00431-010-1252-1","article-title":"Neonatal staphylococcal scalded skin syndrome: Clinical and outbreak containment review","volume":"169","author":"Neylon","year":"2010","journal-title":"Eur. J. Pediatr."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Mishra, A.K., Yadav, P., and Mishra, A. (2016). A systematic review on staphylococcal scalded skin syndrome (SSSS): A rare and critical disease of neonates. Open Microbiol. J., 10.","DOI":"10.2174\/1874285801610010150"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e2","DOI":"10.1017\/ash.2021.161","article-title":"Whole-genome sequencing for neonatal intensive care unit outbreak investigations: Insights and lessons learned","volume":"1","author":"Sansom","year":"2021","journal-title":"Antimicrob. Steward. Healthc. Epidemiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e2124938","DOI":"10.1001\/jamanetworkopen.2021.24938","article-title":"Surveillance for colonization, transmission, and infection with methicillin-susceptible Staphylococcus aureus in a neonatal intensive care unit","volume":"4","author":"Nurjadi","year":"2021","journal-title":"JAMA Netw. 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