Toxic shock syndrome (TSS) caused by methicillin-resistant Staphylococcus aureus (MRSA)
nosocomial infection is a growing concern in both adult and pediatric patients. The reason why TSS appears in only some patients with MRSA
infection remains unclear. In this study, we analyzed serial TSS toxin-1 (TSST-1) antibody in patients with
burn injury to investigate the mechanisms of TSS caused by MRSA
nosocomial infection. This study comprised of patients with
burn injury in our
burn care unit from September, 2010 to August, 2011. Serum samples were collected serially on admission, at 48 to 72 hours after injury, on the day MRSA
infection appeared, and on the day MRSA
infection resolved.
TSST-1 antibody was measured by
enzyme-linked
immunosorbent assay (ELISA). TSS was diagnosed according to the criteria of the Centers for Disease Control. Serial serum samples were collected from 24 patients and nosocomial MRSA
infection was detected in 12 patients. In these 12 patients, TSS occurred in five patients (TSS+ group) but did not occur in the other seven patients (TSS- group).
TSST-1 antibody level was significantly lower in the TSS+ group than TSS- group on admission and on the day MRSA
infection appeared. All patients in the TSS+ group received
intravenous immune globulin when TSS was diagnosed, and no patients died of TSS. Patients suffering from TSS had a lower level of
TSST-1 antibody than patients not suffering from TSS. Testing for
TSST-1 antibody in the clinical setting might help to predict and prevent the appearance of TSS caused by nosocomial MRSA
infection.