title: Infectious disease consultation and microbiologic surveillance for intensive care unit trauma patients: a pilot study.
abstract: Infection remains a major cause of posttrauma morbidity. We retrospectively reviewed 2 cohorts of trauma patients admitted to a regional trauma center before and after a policy change integrating prospective microbiologic surveillance and infectious disease (ID) consultation into management of trauma admissions. Primary interests were effects of this policy change on antimicrobial use and diagnostic precision (particularly differentiation of infection from colonization). Associated costs, microflora, survival, and disability were also compared. Patients were stratified for risk of infection. ID consultation was associated with a 49% increased odds that an infection diagnosis was microbiologically based (P=.006) and 57% reduction of antibiotics costs per hospitalized day (P=.0008). Costs of consultation and an 86% increase (P<10(-6)) in total cultures combined to minimally exceed that financial saving. The observed improvements in diagnostic precision and antimicrobial usage, however, suggest consideration of prospective microbiologic surveillance and multidisciplinary physician teams including ID physicians for high-risk trauma patients.
authors.affiliation: Dean Clinic, Division of Infectious Diseases, Madison, WI 53715, USA. bcfox@facstaff.wisc.edu
authors.forename: B C
authors.initials: BC
authors.lastname: Fox
authors.forename: P B
authors.initials: PB
authors.lastname: Imrey
authors.forename: M B
authors.initials: MB
authors.lastname: Voights
authors.forename: S
authors.initials: S
authors.lastname: Norwood
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D003141:Communicable Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D003428:Cross Infection / Q000150:complications / Q000382:microbiology / Q000401:mortality; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D010865:Pilot Projects; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents