Opsonic activity of blister fluid from burn patients

The combination of skin loss and immune depression after thermal injury predisposes burn patients to an increased risk of infection. Since the commonest site of infection in the burn patient is the burn wound itself, we elected to study the opsonic activity of locally produced blister fluid, from 18 thermally injured patients, for the two most common organisms colonizing the burn wound (Pseudomonas aeruginosa and Staphylococcus aureus). Blister fluid was as good an opsonin source for staphylococcus as normal serum. In contrast, the blister fluid did not support either the phagocytosis of the intracellular killing of P. aeruginosa. The poor opsonic activity of blister fluid for P. aeruginosa did not appear to be due to the presence of an inhibitory factor(s) since the addition of normal serum restored the opsonic activity of the blister fluid to normal. The concentrations of immunoglobulins and the complement components C3 and C4 in the blister fluid samples were less than half the level of those in normal serum. The opsonic activity of the blister fluid could not be restored to normal by the addition of either immunoglobulin or heat-inactivated serum (56 degrees C for 30 min). Thus, the opsonic factor(s) missing from the blister fluid was heat labile and thus probably represents complement components. That blister fluid had impaired opsonic activity for P. aeruginosa but not for S. aureus indicated that a local humoral defect may be responsible, at least in part, for the high incidence of gram-negative organisms, especially pseudomonads, colonizing the burn wound after thermal injury.