Risk factors and outcome of Acinetobacter baumanii infection in severe trauma patients.
OBJECTIVE
To investigate incidence, risk factors and outcome of Acinetobacter baumanii infection in trauma patients.


METHODS
A retrospective analysis of prospectively collected data of all trauma patients admitted to a general intensive care unit (ICU) of a 1,500-bed university hospital over 3 years.


METHODS
Three hundred thirty trauma patients were included in the study.


RESULTS
Thirty-six (10.9%) cases of A. baumanii infection were observed; 29 of them were late onset pneumonia. Patients with A. baumanii infection had a significantly higher Injury Severity Score (ISS) (p = 0.02), a lower Glasgow Coma Scale (GCS) on ICU admission (p = 0.03), stayed longer in the ICU (p = 0.00001), were mechanically ventilated for a longer period of time (p = 0.00001), were more frequently admitted to the emergency department with hypotension (p = 0.02), and had trans-skeletal traction for more than 3 days (p = 0.003) in comparison to the 294 patients who did not develop A. baumanii infection. At multivariate analysis the time spent on mechanical ventilation (p = 0.02) and the presence of long-term trans-skeletal traction (p = 0.04) were the only independent risk factors for A. baumanii infection. Patients with A. baumanii infection had a high mortality rate (9 out of 36; 25.0%). ISS (p = 0.003), GCS (p = 0.001) and older age (p = 0.00001), but not A. baumanii infection (p = 0.15), were independently correlated with mortality.


CONCLUSIONS
In trauma patients prolonged mechanical ventilation and delayed fracture fixation with the persistence of trans-skeletal traction were major risk factors for A. baumanii infection. The presence of this infection was not correlated with mortality.
Caricato
Anselmo
A
Istituto Anestesiologia e Rianimazione, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy. anselmo.caricato@fastwebnet.it
Montini
Luca
L
Bello
Giuseppe
G
Michetti
Vincenzo
V
Maviglia
Riccardo
R
Bocci
Maria G
MG
Mercurio
Giovanna
G
Maggiore
Salvatore M
SM
Antonelli
Massimo
M
D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D040981:Acinetobacter baumannii; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003422:Critical Care; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D017053:Infection Control; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D016015:Logistic Models; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications*; D015999:Multivariate Analysis; D012121:Respiration, Artificial / Q000009:adverse effects / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012384:Rome / Q000453:epidemiology; D018709:Statistics, Nonparametric; D014143:Traction / Q000009:adverse effects / Q000706:statistics & numerical data; D016896:Treatment Outcome