The epidemiologic features of nosocomial infections in patients with trauma
S. E. Pories, R. L. Gamelli, P. B. Mead, G. Goodwin, F. Harris and P. Vacek
Department of Surgery, University of Vermont College of Medicine, Burlington.
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.