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Infectious disease consultation and microbiologic surveillance for intensive care unit trauma patients: a pilot study
B C Fox1, P B Imrey, M B Voights
1Dean Clinic, Division of Infectious Diseases, Madison, WI 53715, USA. bcfox@facstaff.wisc.edu
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.
Insights
Integrating infectious disease (ID) consultation and microbiologic surveillance into trauma care improved diagnostic precision and reduced antibiotic costs. This multidisciplinary approach enhances patient outcomes and optimizes antimicrobial stewardship in trauma management.
Area of Science:
- Infectious Diseases
- Trauma Surgery
- Health Services Research
Background:
- Infection is a significant contributor to morbidity and mortality in trauma patients.
- Current management practices may lead to suboptimal antimicrobial use and diagnostic challenges, distinguishing infection from colonization.
Purpose of the Study:
- To evaluate the impact of integrating prospective microbiologic surveillance and infectious disease (ID) consultation on trauma patient management.
- To assess changes in antimicrobial use, diagnostic precision, costs, and patient outcomes following a policy change.
Main Methods:
- Retrospective review of two trauma patient cohorts (before and after policy implementation).
- Analysis focused on patients stratified by infection risk, comparing outcomes with and without integrated ID consultation and surveillance.
- Key metrics included diagnostic precision, antimicrobial costs, culture utilization, survival, and disability.
Main Results:
- ID consultation increased the odds of microbiologically confirmed infection diagnoses by 49% (P=.006).
- A 57% reduction in daily antibiotic costs was observed (P=.0008).
- Despite increased consultation and culture costs, the overall financial impact was minimal, with significant improvements in diagnostic accuracy and antimicrobial stewardship.
Conclusions:
- Prospective microbiologic surveillance and ID consultation enhance diagnostic precision and optimize antimicrobial use in high-risk trauma patients.
- Multidisciplinary teams, including ID physicians, are recommended for managing complex trauma cases to improve patient care and resource utilization.
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