title: Staphylococcal superantigens and toxins are detectable in the serum of adult burn patients.
abstract: Bacterial infection in burn patients is still a devastating contributor to morbidity and mortality. Little is known regarding the presence of staphylococcal toxins in the burn-injured patient. The aim of this study was to characterize the prevalence of several of these toxins and their relationship to clinical metrics and mortality in burn patients. Levels of exotoxins staphylococcal enterotoxin A (SEA), staphylococcal enterotoxin B, toxic shock syndrome toxin 1 (TSST-1), and α-hemolysin were assayed from the serum of 207 adult burn patients aged 16-92 years. Clinical, demographic, and microbiological data from these patients were then compared to toxin levels. Staphylococcal exotoxins α-hemolysin and SEA were present in 45% and 25% of the population, respectively. Bacterial cultures concomitantly showed a high prevalence of Staphylococcus aureus in 48% of patients, of which 59% were methicillin resistant. Several metrics may be predictive of high toxin concentrations of α-hemolysin and TSST-1 and SEA including burn size, length of stay, and bacteremia. Mortality associations indicated that burn size, bacteremia, age, and the presence of α-hemolysin and SEA may be predictors of mortality. A high prevalence of staphylococcal toxin α-hemolysin and superantigens TSST-1 and SEA can be found in the circulation of the adult burn population. The presence of these toxins may contribute to the morbidity and mortality of the burn patient.
authors.affiliation: The Burn Center, Department of Surgery, MedStar Washington Hospital Center, MedStar Health Research Institute, 110 Irving Street NW, Washington, DC 20010-2975.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Prindeze
authors.affiliation: The Burn Center, Department of Surgery, MedStar Washington Hospital Center, MedStar Health Research Institute, 110 Irving Street NW, Washington, DC 20010-2975.
authors.forename: Bethany M
authors.initials: BM
authors.lastname: Amundsen
authors.affiliation: The Burn Center, Department of Surgery, MedStar Washington Hospital Center, MedStar Health Research Institute, 110 Irving Street NW, Washington, DC 20010-2975.
authors.forename: Anna R
authors.initials: AR
authors.lastname: Pavlovich
authors.affiliation: The Burn Center, Department of Surgery, MedStar Washington Hospital Center, MedStar Health Research Institute, 110 Irving Street NW, Washington, DC 20010-2975.
authors.forename: Dereck W
authors.initials: DW
authors.lastname: Paul
authors.affiliation: The Burn Center, Department of Surgery, MedStar Washington Hospital Center, MedStar Health Research Institute, 110 Irving Street NW, Washington, DC 20010-2975.
authors.forename: Bonnie C
authors.initials: BC
authors.lastname: Carney
authors.affiliation: The Burn Center, Department of Surgery, MedStar Washington Hospital Center, MedStar Health Research Institute, 110 Irving Street NW, Washington, DC 20010-2975.
authors.forename: Lauren T
authors.initials: LT
authors.lastname: Moffatt
authors.affiliation: The Burn Center, Department of Surgery, MedStar Washington Hospital Center, MedStar Health Research Institute, 110 Irving Street NW, Washington, DC 20010-2975. Electronic address: jeffrey.w.shupp@medstar.net.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Shupp
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001427:Bacterial Toxins / Q000032:analysis*; D002056:Burns / Q000150:complications*; D004768:Enterotoxins / Q000032:analysis*; D005260:Female; D006460:Hemolysin Proteins / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D044967:Serum / Q000737:chemistry*; D013203:Staphylococcal Infections / Q000401:mortality / Q000473:pathology*; D018089:Superantigens / Q000032:analysis*; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D001427:Bacterial Toxins; D004768:Enterotoxins; D006460:Hemolysin Proteins; D018089:Superantigens; C030107:enterotoxin F, Staphylococcal; C021091:staphylococcal alpha-toxin; C026066:enterotoxin A, Staphylococcal; C031818:enterotoxin B, staphylococcal
keywords: Burn; Exotoxin; MRSA; Mortality; Staphylococcus aureus; Superantigen