title: Association between early airway damage-associated molecular patterns and subsequent bacterial infection in patients with inhalational and burn injury.
abstract: Bacterial infection is a major cause of morbidity affecting outcome following burn and inhalation injury. While experimental burn and inhalation injury animal models have suggested that mediators of cell damage and inflammation increase the risk of infection, few studies have been done on humans. This is a prospective, observational study of patients admitted to the North Carolina Jaycee Burn Center at the University of North Carolina who were intubated and on mechanical ventilation for treatment of burn and inhalational injury. Subjects were enrolled over a 2-yr period and followed till discharge or death. Serial bronchial washings from clinically indicated bronchoscopies were collected and analyzed for markers of tissue injury and inflammation. These include damage-associated molecular patterns (DAMPs) such as hyaluronic acid (HA), double-stranded DNA (dsDNA), heat-shock protein 70 (HSP-70), and high-mobility group protein B-1 (HMGB-1). The study population was comprised of 72 patients who had bacterial cultures obtained for clinical indications. Elevated HA, dsDNA, and IL-10 levels in bronchial washings obtained early (the first 72 h after injury) were significantly associated with positive bacterial respiratory cultures obtained during the first 14 days postinjury. Independent of initial inhalation injury severity and extent of surface burn, elevated levels of HA dsDNA and IL-10 in the central airways obtained early after injury are associated with subsequent positive bacterial respiratory cultures in patients intubated after acute burn/inhalation injury.
authors.affiliation: Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; North Carolina Jaycee Burn Center, Chapel Hill, North Carolina; robmaile@med.unc.edu.
authors.forename: Robert
authors.identifier: http://orcid.org/0000-0002-9126-4188
authors.initials: R
authors.lastname: Maile
authors.affiliation: Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; North Carolina Jaycee Burn Center, Chapel Hill, North Carolina;
authors.forename: Samuel
authors.initials: S
authors.lastname: Jones
authors.affiliation: Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Yinghao
authors.initials: Y
authors.lastname: Pan
authors.affiliation: Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Haibo
authors.initials: H
authors.lastname: Zhou
authors.affiliation: Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Environmental Medicine, Asthma and Lung Biology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and.
authors.forename: Ilona
authors.initials: I
authors.lastname: Jaspers
authors.affiliation: Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Environmental Medicine, Asthma and Lung Biology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and.
authors.forename: David B
authors.initials: DB
authors.lastname: Peden
authors.affiliation: Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; North Carolina Jaycee Burn Center, Chapel Hill, North Carolina;
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cairns
authors.affiliation: Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Environmental Medicine, Asthma and Lung Biology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and.
authors.forename: Terry L
authors.initials: TL
authors.lastname: Noah
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000473:pathology*; D015415:Biomarkers / Q000378:metabolism*; D001999:Bronchoscopy; D002059:Burns, Inhalation / Q000378:metabolism*; D004247:DNA / Q000378:metabolism; D005260:Female; D024243:HMGB1 Protein / Q000378:metabolism; D018840:HSP70 Heat-Shock Proteins / Q000378:metabolism; D006801:Humans; D006820:Hyaluronic Acid / Q000378:metabolism; D016753:Interleukin-10 / Q000378:metabolism; D008168:Lung / Q000473:pathology; D055370:Lung Injury / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial
chemical_list: D015415:Biomarkers; D024243:HMGB1 Protein; C585491:HMGB1 protein, human; D018840:HSP70 Heat-Shock Proteins; C508609:IL10 protein, human; D016753:Interleukin-10; D006820:Hyaluronic Acid; D004247:DNA
keywords: acute lung injury; burn injury; inhalational injury; innate immunology; respiratory infection