Introduction
Toxic shock syndrome (TSS) is a rare, but potentially catastrophic, complication in paediatric burns. It is typically mediated by the TSST-1 exotoxin, produced by Staphylococcus Aureus (SA) strains in susceptible children. Varying practices exist regarding identification, chemoprophylaxis and treatment of TSS. Our paediatric burn protocol involves TSST-1 testing in all burns, with targeted antibiotics in the event of a positive result. This paper presents our testing protocol and outcomes.
Methodology
Data collection
A retrospective review of our prospectively maintained burns database was performed over a period of 3 years. Data was collated from electronic records.
TSST-1 testing
All paediatric burns are swabbed at presentation to the centre. Plates are checked at 24h. If SA is isolated, the samples are incubated overnight in an enrichment broth, with a Latex agglutination assay performed the following day. TSST-1 positive results are communicated to the burns on call team within 48h from initial swabs and antibiotics are commenced.
Results
1365 swab results, corresponding to 1313 children were identified. 293 (21%) of samples grew SA and TSST-1 assays were performed on them. Only 12 (4% of SA/ 0.9% of all samples) were TSST-1 positive, with all strains sensitive to Flucloxacillin. 3 patients became unwell and were admitted from the community prior to results being known. No cases developed formal TSS, requiring critical care.
Conclusion
Our data shows that TSST-1 testing and targeted antibiotic therapy in paediatric burns is a safe and effective way of identifying and preventing high risk TSS patients.