Infection in hospitalized trauma patients: incidence, risk factors, and complications

Several factors place victims of multiple trauma at increased risk for infection. The purpose of this study was to delineate the frequency of, types of, and risk factors for infection in hospitalized trauma patients.

Prospective surveillance for nosocomial infection was conducted for all trauma patients who were admitted for more than 24 hours to a tertiary-care regional trauma center between January 1 and December 31, 1996.

A total of 563 patients (414 males) with a mean age of 40 years (range, 15-97 years) were followed. Most (86%) sustained blunt traumatic injuries. A total of 367 infections occurred in 209 (37%) patients for an incidence of 32.1/1,000 patient-days. The hospital stay of 37% of patients was complicated by at least one infection, involving the following sites: lower respiratory tract (28%), urinary tract (24%), surgical wound (18%), skin/soft tissue (13%), intra-abdominal (5%), primary bloodstream (5%), and other sites (8%). Infection was complicated by septic shock in 36 (10%) cases, acute respiratory distress syndrome in 32 (9%) cases, and multiorgan failure in 13 (4%) cases. Death was attributed to infection in four patients. In a multivariate analysis, infected patients were more likely to have been ventilated (odds ratio [OR] = 2.6; p<0.001), to have had multiple surgical procedures (OR = 2.8; p = 0.02), to have received multiple blood transfusions (OR = 2.3; p = 0.04), and to have had a spinal cord injury (OR = 5.0; p = 0.002). First surgical procedure within 24 hours of admission was protective (OR = 0.4, p = 0.001).

Trauma patients are at high risk for developing infection. Identifying patients who are at increased risk for infection may allow for early intervention and subsequent decrease in infectious morbidity.