A six-year descriptive study of hospital-associated infection in trauma patients: demographics, injury features, and infection patterns.
OBJECTIVE
Hospital-associated infection (HAI) is of concern to surgeons providing care for traumatized patients, as such patients have a higher rate of infection than other patients. Infection surveillance programs often study trauma patients within other populations (e.g., intensive care unit [ICU], surgery), and important issues may be missed. Information identifying trauma patients at risk, most frequent infection sites, and pathogens is of importance for surveillance and infection control. Measurement is essential to improving care.


METHODS
We evaluated the HAI rate, demographics, injury characteristics, and HAI patterns (microorganisms, sites, antibiotics) in trauma patients (1996-2001). We used two-tailed Mann-Whitney and Fisher exact tests for univariate analysis and a stepwise multivariable logistic regression model for association of multiple variables with the development of HAI.


RESULTS
The incidence of HAI was 501 (9.1%) in 5,537 patients. Trauma patients with HAI were older (p < 0.001), more severely injured (p < 0.001), and more likely to have multi-system trauma (p = 0.027). Development of HAI was associated with all injury sites except the face. The most common pathogens were gram-positive cocci, and the most common infection sites were urinary and respiratory, with 157 of 501 (31%) being ventilator-associated pneumonia. The antibiotics most commonly used were cephalosporins and fluoroquinolones. Of 5,537 trauma patients, 19 (0.3%) had Staphylococcus aureus resistant to methicillin, which was higher (p < 0.001) than in the non-trauma patients (176 in 146,727 [0.1%]).


CONCLUSIONS
Hospital-associated infections occur frequently in trauma patients. This paper identifies populations to target for surveillance and HAI control initiatives. With increased interest in adverse event prevention and continuing quality of care improvement, these data provide a benchmark for this institution and others.
Lazarus
Harrison M
HM
Division of Trauma Services, Department of Clinical Epidemiology, and Department of Medical Informatics, LDS Hospital, Salt Lake City, Utah 94143, USA. ldhlazar@ihc.com
Fox
Jolene
J
Lloyd
James F
JF
Evans
R Scott
RS
Abouzelof
Rouett
R
Taylor
Carrie
C
Pombo
David J
DJ
Stevens
Mark H
MH
Mehta
Rajesh
R
Burke
John P
JP
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014589:Utah / Q000453:epidemiology; D014947:Wounds and Injuries / Q000145:classification / Q000150:complications*