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Human immunodeficiency virus and the trauma patient: factors influencing postoperative infectious complications
A A Guth1, S R Hofstetter, H L Pachter
1Shock and Trauma Unit, Bellevue Hospital Center, New York University Medical Center, NY 10016, USA.
Objective:
While immunosuppression 2 degrees to human immunodeficiency virus (HIV) infection should logically render HIV+ trauma victims more prone to infection after injury, little data is available regarding trauma outcome in this group of patients. Since the helper CD4+ lymphocyte count is a marker for progression of HIV-associated diseases, we examined the relationship between CD4+ counts, Injury Severity Score (ISS), and bacterial infectious complications in HIV+ trauma patients.
Method:
Retrospective review of 56 consecutive HIV+ trauma patients treated at a Level I trauma center.
Results:
Nine patients (15%) developed significant infectious complications (four pneumonias, three soft-tissue infections, one urinary tract infection, one wound infection) with no pattern to the causative agents. Evaluation of CD4+ counts, white blood cell counts, serum albumin levels, blood transfusion requirements, and ISS revealed that only the ISS was associated with infectious complications.
Conclusion:
Despite the profound immunosuppression in this group of patients, the incidence of bacterial infectious complications was independent of the CD4+ count (p = 0.958), but was associated with increases in the ISS (p = 0.003).