A Time-Dependent Analysis of Intensive Care Unit Pneumonia in Trauma Patients

Bochicchio, Grant V.; Joshi, Manjari; Bochicchio, Kelly; Tracy, Kate; Scalea, Thomas M.

doi:10.1097/01.ta.0000109857.22312.df

Cited by 44 publications

(32 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The nosocomial infection rate in trauma patients is very high, notably in ICU [1][2][3][4][5][6][7][8][9]21]. In this study almost one half of patients (45.2%) developed at least 1 infection during their hospitalization in ICU.…”

Section: Discussionmentioning

confidence: 51%

“…Three significant variables were identified in the logistic regression, which are: more than 3 days under MV, number of invasive devices and number of surgeries. Key-Words: Trauma, nosocomial infection, intensive care.The growing complexity of intensive care during recent decades has been accompanied by increased risk of nosocomial infection (NI) [1][2][3][4][5][6][7][8][9]. Patients with multiple traumas have increased survival, and several factors increased risk of NI too [10][11][12].…”

mentioning

confidence: 99%

See 1 more Smart Citation

Risk factors for nosocomial infection in trauma patients

GIAMBERARDINO¹,

Cesário²,

Carmes³

et al. 2007

Braz J Infect Dis

View full text Add to dashboard Cite

Several factors are implicated in the increased vulnerability of multiple trauma victims to infection, especially in intensive care-units (ICU). This cohort study was designed to report the incidence, the topography, the etiology and to identify the risk factors for infection in trauma patients admitted in an ICU. From January 2000 to December 2001, 416 trauma patients were admitted to the ICU for more than 24 hours, the mean length of stay was 9.3 days (range 2-65) and 188 (45%) patients developed a total of 290 NI. The most prevailing infections were pneumonia (49%), bloodstream (19%) and urinary tract infections (12%). The variables studied were: the demographic data, diagnosis on admission, site and mechanism of injury, type and number of surgeries, use of invasive devices, days under mechanical ventilation (MV) and site and number of NI. These variables were analyzed with a univariable and multivariable regression analysis. The NI was associated with injury in more than 1 anatomic segment (OR=1.6; CI 95% 1.06-2.40); mechanical ventilation for more than 3 days (OR=12; CI 95% 6.87-24.02); more than 1 surgery (OR=3.13;CI 95% 1.75-5.65) and more than 2 invasive devices (OR=4.7; CI 95% 2.99-7.37). Deaths over the first 5 days had high association (RR=3.18) with NI. Three significant variables were identified in the logistic regression, which are: more than 3 days under MV, number of invasive devices and number of surgeries. Key-Words: Trauma, nosocomial infection, intensive care.The growing complexity of intensive care during recent decades has been accompanied by increased risk of nosocomial infection (NI) [1][2][3][4][5][6][7][8][9]. Patients with multiple traumas have increased survival, and several factors increased risk of NI too [10][11][12]. The interaction between victims of trauma and intensive care unit (ICU) is considered additive for morbidity, mortality, hospital days, and economic burden for both patient and hospital [13][14][15][16][17][18][19][20][21][22]. The objective of this study was to identify risk factors for NI in ICU. Materials and MethodsHospital do Trabalhador is a trauma referral center in Curitiba (Parana-Brazil).The UCI is a 10-bed unit with singlepatient rooms. Retrospective data was analysed (historical cohort study) from January 2000 tO December 2001. All 416 trauma patients who stayed for more than 24 hours at the ICU were included. Demographic data (age and gender), diagnosis on admission, sites and mechanism of injuries (blunt or penetrating injury), type and number of surgeries, use of invasive devices, days under mechanical ventilation, site and number of NI were recorded. Centers for Disease Control and Prevention's (CDC) [23,24] definitions of nosocomial infection (NI) were utilized. The data was analyzed using Mann-Whitney U Test. Categorical data was assessed using Chi-Square and Mantel-Haenszel Test and Comparison of 2 Proportions. Odds Ratio (OR) with 95% confidence interval was employed to measure the magnitude of association between the studied variables and NI. Logi...

show abstract

Section: Discussionmentioning

confidence: 51%

mentioning

confidence: 99%

Risk factors for nosocomial infection in trauma patients

GIAMBERARDINO¹,

Cesário²,

Carmes³

et al. 2007

Braz J Infect Dis

View full text Add to dashboard Cite

show abstract

“…Devices such as catheters (9) and ventilators (2) that are associated with longer hospital stays and prosthetic and implanted devices such as artificial heart valves, joints, and stents (11) provide surfaces for bacterial attachment, resulting in high rates of morbidity and mortality from nosocomial infections (18,20). In the United States, these infections are estimated to result in a 20% rate of mortality and to have an annual cost of $1 billion (18), so improvements in the prevention and treatment of biofilmrelated persistent infections represent a significant therapeutic opportunity.…”

mentioning

confidence: 99%

High-Throughput Screens for Small-Molecule Inhibitors of Pseudomonas aeruginosa Biofilm Development

Junker

Clardy

2007

Antimicrob Agents Chemother

117

View full text Add to dashboard Cite

Pseudomonas aeruginosa is both a model biofilm-forming organism and an opportunistic pathogen responsible for chronic lung infections in cystic fibrosis (CF) patients and infections in burn patients, among other maladies. Here we describe the development of an efficient high-throughput screen to identify small-molecule modulators of biofilm formation. This screen has been run with 66,095 compounds to identify those that prevent biofilm formation without affecting planktonic bacterial growth. The screen is a luminescence-based attachment assay that has been validated with several strains of P. aeruginosa and compared to a wellestablished but low-throughput crystal violet staining biofilm assay. P. aeruginosa strain PAO1 was selected for use in the screen both because it forms robust biofilms and because genetic information and tools are available for the organism. The attachment-inhibited mutant, strain PAO1 ⌬fliC, was used as a screening-positive control. We have also developed and validated a complementary biofilm detachment assay that can be used as an alternative primary screen or secondary screen for the attachment screening-positive compounds. We have determined the potencies of 61 compounds against biofilm attachment and have identified 30 compounds that fall into different structural classes as biofilm attachment inhibitors with 50% effective concentrations of less than 20 M. These small-molecule inhibitors could lead to the identification of their relevant biofilm targets or potential therapeutics for P. aeruginosa infections.Establishment of a bacterial infection in the form of a biofilm, a complex, three-dimensional, attached bacterial community, can have devastating consequences for patient morbidity and mortality. Individual cells within a biofilm are slowly growing and are embedded in an exopolymeric substance. These biofilm cells are relatively insensitive to many environmental stresses, including antibiotics and host immune responses (6). Because of the biofilm cells' intrinsic resistance to antibiotics, the infections that they cause persist, and eradication of these biofilm-related infections is a challenge (7). A new strategy for combating biofilms and persistent infections is desperately needed.Biofilm infections cause, contribute to, or complicate several conditions, including endocarditis, burns, periodontal disease, ear infections, chronic urinary tract infections, and pneumonia in patients with cystic fibrosis (CF) (7,29). Devices such as catheters (9) and ventilators (2) that are associated with longer hospital stays and prosthetic and implanted devices such as artificial heart valves, joints, and stents (11) provide surfaces for bacterial attachment, resulting in high rates of morbidity and mortality from nosocomial infections (18,20). In the United States, these infections are estimated to result in a 20% rate of mortality and to have an annual cost of $1 billion (18), so improvements in the prevention and treatment of biofilmrelated persistent infections represent a significant therape...

show abstract

“…The effects of age on the mortality rate of critically ill patients have been well documented, with the finding that it is an independent predictor of death [8][9][10][11]. The same association between greater age and poor outcome has been proposed in the case of trauma patients [12][13][14][15][16]. In the present study, the average age of the nonsurvivors was below the common definitions of older age in trauma patients, which range from 55 [13,17] to 65 years [14].…”

Section: Discussionmentioning

confidence: 95%