The Epidemiologic Features of Nosocomial Infections in Patients With Trauma

Abstract

Sepsis is a major cause of morbidity and mortality in patients with trauma. To elucidate factors that might lead to infection, we studied the epidemiologic characteristics of nosocomial infections in our patient population with trauma. During a 3.5-year period, 2496 patients were entered into our hospital trauma registry and cross-matched with hospital infection control surveillance information. Two hundred twenty-nine patients with trauma and nosocomial infections were identified (9.2%), a figure that was nearly twice the nosocomial infection rate for the general hospital population. The majority of those infected were either orthopedic (51%), general surgical (25%), or neurosurgical (13%) patients. The most common sites of first infection were urinary tract (61%) or respiratory system (14%). Patients developing nosocomial infections were significantly older and had a higher Injury Severity Score than those who did not. Injury site was related to risk of infection with injuries of the spine, chest, and extremity showing the most significant relationship. The length of stay as well as hospital charges were significantly related to the occurrence of infectious complications. By determining the patient with trauma at risk for infection, treatment strategies can be designed to minimize septic complications.

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

“…Desse total, 215 (15,6%) adquiriram pelo menos uma infecção durante o período de hospitalização, representando a população do estudo. 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).…”

“…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.…”

Infections in traumatised patients: A growing medico-surgical concern

“…[11] The overall incidence of infections following trauma varies from 9-36%. [11][12][13][14] This is much higher than the rates of nosocomial infection for general population. [12] In a large series of 10,308 trauma patients admitted to the Maryland institute for Emergency Medical Service systems between 1977 and 1984, 2310 infections were reported in 1407 patients.…”

“…Host factors include the age, since geriatric and paediatric trauma patients are more prone to infections [12] and require more care and resources. Underlying immunosuppression, diabetes, malnutrition, and other underlying illnesses in the traumatized patient also predispose to infections.…”

“…in the wound, shock and requirement of blood transfusion. [7,12,14] Other factors like injury to the spine, chest and extremity, multiple trauma and hypotension are also more commonly found in patients developing infection. [12] Trauma by itself jeopardizes the host's natural protective barriers by disrupting the integrity of skin and tissues.…”