Posttraumatic auto-oxidative polymorphonuclear neutrophil receptor injury predicts the development of nosocomial infection

H. H. Simms and R. D'Amico
Department of Surgery, Rhode Island Hospital/Brown University School of Medicine, Providence, USA.

OBJECTIVE: To determine the mechanisms and prevalence of posttraumatic auto-oxidative receptor injury and immune suppression to subsequent nosocomial infections. DESIGN: Purified polymorphonuclear neutrophils from 30 critically ill trauma patients (mean [+/- SD] Injury Severity Scores, 21.5 +/- 7.3) were incubated with glucose and glucose-oxidase to generate superoxide anion. Subcellular fractionations were performed with iodine 1125 monoclonal antibodies against the Fc receptors CD32w and CD16 and complement receptors CD35 and CD11b/CD18. Plasma membrane expression of these receptors was then determined during the first week of hospitalization. SETTING: Surgical intensive care unit in a university-affiliated hospital. RESULTS: Twenty-three (77%) of 30 patients had persistent auto-oxidative reduction in Fc and complement receptors induced by glucose and glucose-oxidase. Nosocomial infections occurred in 20 (87%) of 23 patients with auto-oxidative injury vs 1 (14%) of 7 patients without auto-oxidative receptor injury (P < .01, unpaired t test). Patients without auto-oxidative injury had expression for each receptor no different from buffer control. CONCLUSIONS: Critically ill trauma patients have auto-oxidative receptor injury, which is closely linked with the development of nosocomial infections. These results provide a biological basis for the early use of auto-oxidants in critically ill trauma patients.