Granulocyte function and Pseudomonas burn wound infection

Enhancement of neutrophil function by interleukin-18 therapy protects burn-injured mice from methicillin-resistant Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) infection is a grave concern in burn-injured patients. We investigated the efficacy of interleukin-18 (IL-18) treatment in postburn MRSA infection. Alternate-day injections of IL-18 into burn-injured C57BL/6 mice significantly increased their survival after MRSA infection and after methicillin-sensitive S. aureus infection. Although IL-18 treatment of burn-injured mice augmented natural IgM production before MRSA infection and gamma interferon (IFN-γ) production after MRSA infection, neither IgM nor IFN-γ significantly contributed to the improvement in mouse survival. IL-18 treatment increased/restored the serum tumor necrosis factor (TNF), IL-17, IL-23, granulocyte colony-stimulating factor (G-CSF), and macrophage inflammatory protein (MIP-2) levels, as well as the neutrophil count, after MRSA infection of burn-injured mice; it also improved impaired neutrophil functions, phagocytic activity, production of reactive oxygen species, and MRSA-killing activity. However, IL-18 treatment was ineffective against MRSA infection in both burn- and sham-injured neutropenic mice. Enhancement of neutrophil functions by IL-18 was also observed in vitro. Furthermore, when neutrophils from IL-18-treated burn-injured mice were adoptively transferred into nontreated burn-injured mice 2 days after MRSA challenge, survival of the recipient mice increased. NOD-SCID mice that have functionally intact neutrophils and macrophages (but not T, B, or NK cells) were substantially resistant to MRSA infection. IL-18 treatment increased the survival of NOD-SCID mice after burn injury and MRSA infection. An adoptive transfer of neutrophils using NOD-SCID mice also showed a beneficial effect of IL-18-activated neutrophils, similar to that seen in C57BL/6 mice. Thus, although neutrophil functions were impaired in burn-injured mice, IL-18 therapy markedly activated neutrophil functions, thereby increasing survival from postburn MRSA infection.

Macrophage dysfunction after burn injury

The phagocytic and microbicidal activities of alveolar and peritoneal macrophages were evaluated 4 and 24 h after a full-thickness scald burn of 26 to 28% body surface area in anesthetized rats. The contribution of serum factors to the macrophage functions was studied concurrently. The phagocytic activity of alveolar macrophages obtained 4 or 24 postburn was reduced approximately 65% below control values when they were incubated in media containing autologous serum and approximately 45% (below controls) when they were incubated in media containing normal (control) serum. A similar, although not as marked, decrease in the phagocytic activity of peritoneal macrophages was also demonstrated. Serum obtained from rats 4 or 24 h postburn had a significant suppressive effect on the phagocytic activity of control alveolar, but not peritoneal, macrophages. The intracellular microbicidal activity of peritoneal macrophages obtained at the postburn intervals and incubated in media containing either autologous or control serum was unaltered from control values. However, alveolar macrophages obtained 24 h, but not 4 h, postburn had a significant (approximately 80%) increase, above control values, in their microbicidal activity. Serum obtained 24 h, but not 4 h, postburn stimulated control alveolar macrophage killing ability. These data indicate that thermal injury induces a defect in the phagocytic activity rather than the microbicidal activity of macrophages. This phagocytic alteration is mediated, in part, by serum.

The burn patient: II. Later care and complications of thermal injury

The care necessary for the extensively burned patient is of an intensity, variety and duration most effectively and economically provided by the multidisciplinary staff of a specialized treatment facility. The organization of burn care in the United States has been well regionalized in recognition of this fact. The burn care given and the research carried out at burn units and burn centers has led to the identification of the pathophysiologic changes, the development of new treatments and the improvement in functional result and survival described in this review.