title: High incidence of post-injury pneumonia in intensive care-treated trauma patients.
abstract: BACKGROUND
  Trauma patients are susceptible to post-injury infections. We investigated the incidence, as well as risk factors for development of pneumonia in intensive care unit (ICU)-treated trauma patients. In addition, we report pathogens identified in patients that developed pneumonia.
  
  
  METHODS
  The study cohort consisted of 322 trauma patients admitted to the ICU at a level-one trauma centre following initial resuscitation. Patients 15 years or older with an ICU stay of more than 24 h were included. We investigated pre-hospital and hospital parameters during the first 24 h after admission and their possible association with pneumonia within 10 days of ICU admission.
  
  
  RESULTS
  Majority of the patients were male (78%) and the median age was 41 years. The overall degree of injury was high with a median Injury Severity Score (ISS) of 24. Overall 30-day mortality was 9%. Eighty-five (26%) patients developed pneumonia during their first 10 days in the ICU. Univariate logistic regression revealed that intubation in the field, shock, Glasgow Coma Scale (GCS) 3-8, major surgery within 24 h after admission, massive transfusion and ISS > 24 were all risk factors for subsequent development of pneumonia. In the multivariable model, only GCS 3-8 was identified as an independent risk factor. In 42 out of the 85 cases of pneumonia, the diagnosis was defined by significant growth of at least one pathogen where Enterobacteriaceae and Staphylococcus aureus were the most common.
  
  
  CONCLUSIONS
  Pneumonia is a common complication among ICU-treated trauma patients. Reduced consciousness is an independent risk factor for development of pneumonia after severe injury.
authors.affiliation: Section of Anesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. petra.hyllienmark@karolinska.se
authors.forename: P
authors.initials: P
authors.lastname: Hyllienmark
authors.forename: O
authors.initials: O
authors.lastname: Brattström
authors.forename: E
authors.initials: E
authors.lastname: Larsson
authors.forename: C-R
authors.initials: CR
authors.lastname: Martling
authors.forename: J
authors.initials: J
authors.lastname: Petersson
authors.forename: A
authors.initials: A
authors.lastname: Oldner
mesh_terms: D018806:APACHE; D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015897:Comorbidity; D003244:Consciousness Disorders / Q000150:complications / Q000453:epidemiology; D003422:Critical Care; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012769:Shock / Q000453:epidemiology; D013898:Thoracic Injuries / Q000150:complications; D014193:Trauma Centers / Q000706:statistics & numerical data; D014946:Wound Infection / Q000453:epidemiology; D014947:Wounds and Injuries / Q000150:complications* / Q000628:therapy; D014950:Wounds, Penetrating / Q000453:epidemiology