Comparison of hemodynamic changes resulting from toxic shock syndrome toxin-1-producing Staphylococcus aureus sepsis and endotoxin-producing gram-negative rod sepsis in patients with severe burns.

Five patients with burns and toxic shock syndrome toxin-1 (TSST-1)-producing Staphylococcus aureus sepsis (TSS group) were treated in a 5-year period at Kyorin University Hospital's Traumatology and Critical Care Center Burn Unit. Hemodynamic and metabolic differences in these patients were compared retrospectively with those in another five patients who were matched by burn index and age and in whom endotoxin-producing gram-negative rod sepsis developed (End group). Both groups showed hypermetabolic and hyperdynamic changes at the point sepsis developed. There were no significant differences between the two groups in any parameter. At the point septic shock developed, the TSS group showed significantly lower mean (+/- SD) arterial pressure (TSS vs End group, 64 +/- 5 vs 74 +/- 5 mm Hg; p < 0.05), significantly lower systemic vascular resistance index (TSS vs End group, 579 +/- 62 vs 729 +/- 75 dynes.sec.cm-5/m2; p < 0.05), and higher oxygen consumption (TSS vs End group, 190 +/- 7 vs 163 +/- 11 L/min/m2; p < 0.05) compared with the End group. This is the first clinical report that asserts that TSST-1-producing gram-positive sepsis may result in more hypermetabolic and hyperdynamic differences than does endotoxin-producing gram-negative rod septic shock. These responses may indicate a stronger stimulation of cytokine and nitrous oxide synthetic activity by TSST-1 than by endotoxin.