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Postoperative toxic shock syndrome

D R Graham1, M O'Brien, J M Hayes

  • 1Springfield Clinic, Southern Illinois University School of Medicine 62794-9248, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|April 1, 1995
PubMed
Summary
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Postoperative toxic shock syndrome (PTSS) is rare, affecting 0.003% of surgeries. Staphylococcus aureus was found in all cases, but all patients survived with prompt treatment.

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.

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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.