PATTERNS OF STAPHYLOCOCCUS-AUREUS COLONIZATION, TOXIN PRODUCTION, IMMUNITY AND ILLNESS IN BURNED CHILDREN

Toxic shock syndrome toxin-one (TSST-1) produced from some but not all strains of Staphylococcus aureus is considered to be responsible for the development of the serious illness, toxic shock syndrome (TSS). The aim of this study was to establish the importance of S. aureus in the aetiology of suspected cases of TSS in acutely burned children. The pattern of colonization of S. aureus, and in particular toxic shock syndrome toxin-one (TSST-1) producing isolates, was studied in 53 burned children admitted as consecutive cases. S. aureus was not normally present on admission. Although it was the most common wound pathogen, it was acquired during the first few days after admission. Antibody status to TSST-1 on admission and at discharge was determined. Only half (49 per cent) of the children had antibodies to TSST-1. When it was possible to obtain paired admission and discharge samples in patients who had been given blood products, an assessment of seroconversion could be made. Two of the four patients given blood products during the resuscitation and postoperative period were antibody negative on admission (the other two were TSST-1 antibody positive). By discharge they had antibodies to TSST-1. Whilst the majority of donated blood products had antibodies to TSST-1 (76 per cent), some (24 per cent) did not. Seven of 53 children (13 per cent) developed a toxic shock-like illness which caused clinical concern. S. aureus was isolated from the wounds of five of the children but only one child (patient 4, who was TSST-1 antibody positive) had a TSST-1 producing isolate of S. aureus in his wound. Three children who had an uneventful postburn recovery had a TSST-1-producing isolate in their wounds. Clinical diagnosis of a toxin-like illness was not supported by evidence of the TSST-1-producing S. aureus isolate. Other staphylococcal enterotoxins as well as toxins from other species may have played a role in the development of illness in the other six patients.