Multi-Drug-Resistant Gram-Negative Infections in Deployment-Related Trauma Patients
Wesley R Campbell1, Ping Li2,3, Timothy J Whitman4
11 Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, Maryland.
Background:
The contribution of multi-drug-resistant gram-negative bacilli infections (MDRGN-I) in patients with trauma is not well described. We present characteristics of MDRGN-Is among military personnel with deployment-related trauma (2009-2014).
Patients And Methods:
Data from the Trauma Infectious Disease Outcomes Study were assessed for infectious outcomes and microbial recovery. Infections were classified using standardized definitions. Gram-negative bacilli were defined as multi-drug-resistant if they showed resistance to ≥3 antibiotic classes or were producers of extended-spectrum β-lactamase or carbapenemases.
Results:
Among 2,699 patients admitted to participating U.S. hospitals, 913 (33.8%) experienced ≥1 infection event, of which 245 (26.8%) had a MDRGN-I. There were 543 MDRGN-I events (24.6% of unique 2,210 infections) with Escherichia coli (48.3%), Acinetobacter spp. (38.6%), and Klebsiella pneumoniae (8.4%) as the most common MDRGN isolates. Incidence of MDRGN-I was 9.1% (95% confidence interval [CI]: 8.0-10.2). Median time to MDRGN-I event was seven days with 75% occurring within 13 days post-trauma. Patients with MDRGN-Is had a greater proportion of blast injuries (84.1% vs. 62.5%; p < 0.0001), traumatic amputations (57.5% vs. 16.3%; p < 0.0001), and higher injury severity (82.0% had injury severity score ≥25 vs. 33.7%; p < 0.0001) compared with patients with either no infections or non-MDRGN-Is. Furthermore, MDRGN-I patients were more frequently admitted to the intensive care unit (90.5% vs. 48.5%; p < 0.0001), colonized with a MDRGN before infection (58.0% vs. 14.7%; p < 0.0001), and required mechanical ventilation (78.0% vs. 28.8% p < 0.0001). Antibiotic exposure before the MDRGN-I event was significantly higher across antibiotic classes except first generation cephalosporins and tetracyclines, which were very commonly used with all patients. Regarding outcomes, patients with MDRGN-Is had a longer length of hospitalization than the comparator group (53 vs. 18 days; p < 0.0001).
Conclusions:
We found a high rate of MDRGN-I in our population characterized by longer hospitalization and greater injury severity. These findings inform treatment and infection control decisions in the trauma patient population.
Insights
Multi-drug-resistant gram-negative bacilli infections (MDRGN-I) are common in trauma patients, leading to longer hospital stays and increased injury severity. Understanding MDRGN-I characteristics is crucial for effective treatment and infection control in this population.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Military Health
Background:
- Multi-drug-resistant gram-negative bacilli infections (MDRGN-I) in trauma patients are not well-documented.
- This study characterizes MDRGN-Is in military personnel with deployment-related trauma.
Purpose of the Study:
- To describe the incidence, characteristics, and outcomes of MDRGN-Is in a cohort of military trauma patients.
- To identify risk factors and clinical features associated with MDRGN-Is in trauma survivors.
Main Methods:
- Retrospective analysis of data from the Trauma Infectious Disease Outcomes Study (2009-2014).
- Infections were classified using standardized definitions; MDRGNs were defined by antibiotic resistance patterns.
- Microbial recovery and infectious outcomes were assessed for 2,699 trauma patients.
Main Results:
- MDRGN-I occurred in 26.8% of infected patients (9.1% incidence), with Escherichia coli, Acinetobacter spp., and Klebsiella pneumoniae as common isolates.
- MDRGN-I patients had higher injury severity, more blast injuries, traumatic amputations, and greater ICU admission and mechanical ventilation rates.
- Median time to MDRGN-I was 7 days, with 75% occurring within 13 days; patients experienced significantly longer hospitalizations (53 vs. 18 days).
Conclusions:
- A high rate of MDRGN-I was observed in military trauma patients, associated with severe injuries and prolonged hospitalization.
- Findings highlight the need for targeted treatment and infection control strategies for MDRGN-I in trauma care.
- Early identification and management of MDRGN colonization and infection are critical for improving outcomes.
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