Postoperative toxic shock syndrome

Area of Science:

• Infectious Diseases
• Surgical Site Infections
• Toxicology

Background:

• Postoperative toxic shock syndrome (PTSS) is a rare but serious complication.
• Early studies indicated a link between Staphylococcus aureus and PTSS.

Purpose of the Study:

• To determine the incidence of PTSS in community hospitals.
• To identify risk factors and clinical characteristics of PTSS.
• To emphasize the importance of early diagnosis and treatment.

Main Methods:

• Retrospective review of surgical procedures from 1981-1993.
• Analysis of 12 confirmed cases of PTSS.
• Microbiological analysis of wound cultures.
• Review of patient demographics, clinical presentation, and outcomes.

Main Results:

• The incidence of PTSS was 0.003% (12 cases out of 390,000 procedures).
• Staphylococcus aureus was isolated from all PTSS wound cultures, with susceptibility to common antibiotics.
• Common clinical features included high fever (mean 40°C), rash, and desquamation.
• Mean onset of symptoms was 4 days post-surgery, requiring aggressive fluid resuscitation.
• No correlation found between PTSS and patient age, sex, preoperative care, or surgical factors.
• All 12 patients with PTSS survived.

Conclusions:

• PTSS is an uncommon but significant postoperative complication.
• Staphylococcus aureus is consistently implicated in PTSS.
• Early recognition and management are crucial for patient survival.
• PTSS should be considered in febrile, systemically ill postoperative patients, irrespective of wound appearance.