Haemophilus pneumonia is a common cause of early pulmonary dysfunction following trauma
D. A. Spain, M. A. Wilson, P. W. Boaz, M. F. Bar-Natan and R. N. Garrison
Department of Surgery, University of Louisville, Ky, USA.
BACKGROUND: Haemophilus species are a common cause of community-acquired
pneumonia; however, their significance in posttraumatic pneumonia is
unclear. DESIGN: Case series. SETTING: University hospital, level I trauma
center. PATIENTS: Two hundred fifty-seven consecutive patients with blunt
and penetrating trauma treated for pneumonia. MAIN OUTCOME MEASURES: Length
of stay in the intensive care unit, duration of ventilatory support, rate
of recurrent or persistent pneumonia, and mortality. RESULTS: Ninety-six
(37%) of 257 patients treated for pneumonia had a Haemophilus species
isolated on sputum culture. Of these 96 patients, 49 (51%) had only
Haemophilus species, while 33 (34%) had associated gram-positive organisms
and 14 (15%) had gram-negative organisms. Seventeen pure cultures (29%) and
seven mixed cultures (15%) (P < .05) were beta-lactamase-positive
trains. Compared with patients who had pneumonia caused by other bacteria,
patients with Haemophilus species were younger (mean +/- SE, 35 +/- 1.7 vs
42 +/- 1.6 years; P < .05) and more severely injured (Injury Severity
Score, 20.7 +/- 1.1 vs 17.5 +/- 0.9; P < .05). There were no differences
in any outcome variables between the two groups. Only one (1%) of 96
patients had persistent Haemophilus species on sputum cultures after 7 days
of treatment. CONCLUSIONS: Haemophilus species are a frequent cause of
pneumonia following traumatic injury. This occurs primarily in the early
postinjury phase and therefore should be included in the differential
diagnosis of early posttraumatic pulmonary insufficiency.
