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A Retrospective Case-Control Study

Anthony P. Borzotta, MD; Kathleen Beardsley, RN, MS

Arch Surg. 1999;134:657-665.

Hypothesis  We sought to determine whether the usual risk factors for fungal infections are applied to trauma patients.

Design  Case-control study.

Setting  American College of Surgeons Committee on Trauma–certified Level I trauma center in a tertiary care community hospital.

Patients  Screening of medical records of a consecutive sample of 459 patients aged 16 years or older admitted to an intensive care unit for 4 days or more from 1993 through 1996 identified 20 patients infected with Candida species. Two case controls for each were selected from the remaining patients using sex, age within 5 years, mechanism of injury, and best fit of first 4 Abbreviated Injury Scale scores; the Injury Severity Score and intensive care unit length of stay were also used if needed.

Interventions  None.

Results  Univariate analyses by t and ² tests showed significance (P<.05) for number of units of blood transfused in the first 24 hours after injury, gastrointestinal perforation, hemodialysis, and total parenteral nutrition. Steroids, fungal colonization, use of central venous catheters, Acute Physiology and Chronic Health Evaluation II score, mechanical ventilation for 3 days or more, and the number and duration of antibiotics were not significantly different. Logistic regression analysis showed that only total parenteral nutrition was an independent risk factor in this trauma population.

Conclusion  Many of the classic risk factors for fungal infection in other populations are actually concomitants of injury severity and its requisite level of care in trauma patients. Hyperalimentation in persistently critically ill trauma patients significantly increases the risk of Candida infection.

From the Trauma Service, Legacy Emanuel Hospital, Portland, Ore.

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