Infection in Hospitalized Trauma Patients: Incidence, Risk Factors, and Complications

Papia, Giuseppe; McLellan, Bruce N.; El‐Helou, Philippe; Louie, Marie; Rachlis, Anita; Szalai, John‐Paul; Simor, Andrew E.

doi:10.1097/00005373-199911000-00018

Cited by 153 publications

(99 citation statements)

References 13 publications

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“…The rate of organ/intra-abdominal SSIs can be as high as 12%. [22][23][24] Among the patients included in the present study, there were 85 SSIs (13.8%), a value that is comparable to that report ed in the literature. 1,8,22 Identifying independent risk factors for infection in trauma patients is a difficult task.…”

Section: Discussionsupporting

confidence: 88%

Surgical site infection in abdominal trauma patients: risk prediction and performance of the NNIS and SENIC indexes

et al. 2011

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Background:The National Nosocomial Infections Surveillance (NNIS) and Efficacy of Nosocomial Infection Control (SENIC) indexes are designed to develop control strategies and to reduce morbidity and mortality rates resulting from infections in surgical patients. We sought to assess the application of these indexes in patients undergoing surgery for abdominal trauma and to develop an alternative model to predict surgical site infections (SSIs). Methods:We conducted a prospective cohort study between November 2000 and March 2002. The main outcome measure was SSIs. We evaluated the variables included in the NNIS and SENIC indexes and some preoperative, intraoperative and postoperative variables that could be risk factors related to the development of SSIs. We performed multivariate analyses using a forward logistic regression method. Finally, we assessed infection risk prediction, comparing the estimated probabilities with actual occurrence using the areas under the receiver operating characteristic (ROC) curves. Results:Overall, 614 patients underwent an exploratory laparotomy. Of these, 85 (13.8%) experienced deep incisional and organ/intra-abdominal SSIs. The independent variables associated with this complication were an Abdominal Trauma Index score greater than 24, abdominal contamination and admission to the intensive care unit. We proposed a model for predicting deep incisional and organ/ intra-abdominal SSIs using these variables (alternative model). The areas under the ROC curves were compared using the estimated probabilities for this alternative model and for the NNIS and SENIC scores. The analysis revealed a greater area under the ROC curve for the alternative model. The NNIS and SENIC scores did not perform as well as the alternative model in patients with abdominal trauma. Conclusion:The NNIS and SENIC indexes were inferior to the proposed alternative model for predicting SSIs in patients undergoing surgery for abdominal trauma.

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Section: Discussionsupporting

confidence: 88%

Surgical site infection in abdominal trauma patients: risk prediction and performance of the NNIS and SENIC indexes

et al. 2011

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“…Estudos evidenciam que a prevalência das IRAS em pacientes traumatizados oscila entre 9,2% e 42% (CARICATO et al, 2009;PORIES et al, 2001 Os principais sítios infecciosos observados no atual estudo foram o pulmão (49,5%), seguido pelo trato urinário (23,8%) e sítio cirúrgico (10,5%), apresentados na figura 1. Corroborando com esses dados, pesquisa canadense realizada com 563 pacientes, mostrou predomínio da pneumonia, 28,0%, seguida da infecção do trato urinário (ITU), 24,0% e do sítio cirúrgico, 18,0% (PAPIA et al, 1999). Estudo italiano evidenciou as infecções da corrente sanguínea (13,7%) dentre as mais prevalentes em pacientes acometidos por trauma (CARICATO et al, 2009).…”

Section: Resultsunclassified

“…A relação das IRAS com óbitos de pacientes acometidos por trauma também foi observada em outras instituições, contudo, contribuiram para um menor número de mortes. Em estudo realizado em uma unidade de trauma canadense, dos 31 pacientes que evoluíram a óbito, 15 (48,3%) adquiriram infecção, sendo que em quatro pacientes a infecção foi a causa direta do óbito (PAPIA et al, 1999). Em pesquisa norte americana, a mortalidade foi significativamente mais elevada em pacientes com IRAS (10%) se comparada a pacientes que não desenvolveram infecção (2%) (PORIES et al, 2001 A relevância deste estudo deu-se pela caracterização das IRAS em pacientes acometidos por trauma, elucidação dos fatores de risco para o desenvolvimento destas infecções e relação com o óbito.…”

Section: Resultsunclassified

Impacto das infecções relacionadas à assistência à saúde em pacientes acometidos por trauma

Watanabe

Almeida

Ottunes

et al. 2015

Semin. Cienc. Biol. Saude

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As infecções relacionadas à assistência hospitalar impactam negativamente a saúde de pacientes hospitalizados, e refletem em elevados índices de morbimortalidade. Este estudo epidemiológico descritivo teve como objetivo caracterizar as infecções e avaliar seu impacto na saúde de pacientes acometidos por trauma, em um hospital universitário, no período de um ano. Os resultados mostraram que a prevalência das infecções nos pacientes do estudo foi elevada (15,6%), acometendo principalmente o sexo masculino (80,0%), com idade entre 18 e 40 anos (47,5%), período de internação maior que 15 dias (78,6%), mais frequente no trauma fechado (54,0%) e nas queimaduras (32,5%). Os principais sítios de infecção foram a pneumonia (49,5%) seguida pela infecção do trato urinário (23,8%). A intubação orotraqueal e o cateterismo vesical de longa permanência estiveram significativamente relacionados à maioria das pneumonias (60,3%; p<0,001) e infecções do trato urinário (77,3%; p<0,001), aumentando os riscos para tais infecções em 20 e 6 vezes, respectivamente. A sepse acometeu 44,7% dos pacientes. Ampla gama de microrganismos apresentou resistência aos antimicrobianos, sendo Acinetobacter baumannii (92,7%, p<0,001) e Klebsiella pneumoniae (70,5%, p<0,001) os mais prevalentes. Evoluíram a óbito 28,8% dos pacientes, e 96,8% das mortes relacionavam-se às infecções. A relação das infecções com o óbito foi estatisticamente significativa em pacientes com pneumonia (37,8%, p<0,001) e sepse (54,2%, p<0,001). A relação das infecções com a maioria dos óbitos evidenciou o impacto negativo desta complicação na saúde das vítimas de traumas. ResumoHealthcare associated infections have an impact on the health of hospitalized patients and are reflected in high rates of morbidity and mortality. The aim of this descriptive study is to characterize the infections and evaluate their impact on trauma patient health at a University Hospital over a 1-year period. The results showed that the prevalence of infections in trauma patients was elevated (15.6%), affecting mainly males (80.0%), ages between 18 and 30 years (47.5%), more than 15 days hospitalization (78.6%), more frequent in blunt trauma (54.0%) and in burns (32.5%). The principal sites of infection were pneumonia (49.5%) Palavras-chave: Infecção hospitalar. Sepse. Epidemiologia. Causas externas.

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“…SCI is a risk factor for infection. 1,2 Hence, nosocomial infection rates are high especially during the acute hospitalisation period 3,4 with reports of a proportion of 25.8% of patients being significantly greater than that for non-SCI admissions. As described previously, bacteriuria is almost universal in patients with SCI and is often an asymptomatic colonisation, but will recur throughout their lives and can cause serious problems (eg bacteremia, calculi, pyelonephritis, renal failure, etc).…”

Section: Introductionmentioning

confidence: 99%

Urinary infections in patients with spinal cord injury

et al. 2003

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Study design: A retrospective study concerning urinary tract infections in spinal cord injury (SCI) patients. Objectives: To check whether the regular (1/week) urine cultures allow a more accurate treatment of urinary tract infections in SCI patients compared to empiric treatment. Setting: Ghent University Hospital, East-Flanders, Belgium. Methods: Group 1: 24 tetraplegic patients; group 2: 22 paraplegic patients; group 3: 28 other polytrauma patients as controls. These groups were chosen as catheterisation and other voiding methods differ according to the underlying pathology.Results: An average of four clinically significant episodes of bacteriuria were found for groups 1 and 2, while group 3 experienced very few urinary infections. The mean species turnover of the first two groups was 2. No statistically significant difference was found in antibiotic-resistance patterns of organisms isolated. Conclusion: Despite different catheterisation techniques in para-and tetraplegic patients, we conclude that: (1) the number of episodes of clinical significant nosocomial urinary infections is not different; (2) the mean species turnover is the same; (3) because of the species turnover, the value of regular urine cultures for 'documented' treatment of clinical relevant urinary infections seems to be limited. So urine culture could be performed less frequently or only when therapy becomes mandatory; (4) No oral antibiotic with superior activity was found: treatment is best started empirically (after sampling for urine culture) and adjusted to the resulting antibiotic sensitivity screening.

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Infection in Hospitalized Trauma Patients: Incidence, Risk Factors, and Complications

Abstract: Trauma patients are at high risk for developing infection. Identifying patients who are at increased risk for infection may allow for early intervention and subsequent decrease in infectious morbidity.

Cited by 153 publications

References 13 publications

Surgical site infection in abdominal trauma patients: risk prediction and performance of the NNIS and SENIC indexes

Surgical site infection in abdominal trauma patients: risk prediction and performance of the NNIS and SENIC indexes

Impacto das infecções relacionadas à assistência à saúde em pacientes acometidos por trauma

Urinary infections in patients with spinal cord injury

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