Dhiman Nitasha, Rimal Ram C, Hamill Mark, Love Katie M, Lollar Daniel, Collier Bryan
1 Virginia Tech Carilion School of Medicine , Roanoke, Virginia.
2 Carilion Roanoke Memorial Hospital , Roanoke, Virginia.
Surg Infect (Larchmt). 2017 Jul;18(5):550-557. doi: 10.1089/sur.2016.206. Epub 2017 May 24.
Hospital-acquired infections (HAI) in trauma patients increase inpatient morbidity and mortality. However, their impact on long-term mortality is not well understood.
A retrospective trauma registry analysis of all patients admitted to an academic level I trauma center between July 1, 2008 and December 31, 2012 was performed. Patients included survived to discharge and were 18 years of age or older. Age, gender, Injury Severity Score (ISS), ventilator use, history of chronic obstructive pulmonary disease (COPD), and HAI were reviewed. Name, social security number, and date of birth were used to extract National Death Index data from 2008-2013 for an outcome of mortality after discharge, time to death, and cause of death. Unadjusted logistic regression was performed. Multiple logistic regression was used to adjust for patient and injury characteristics and to determine odds of mortality in the post-discharge period.
A total of 8,275 patients met inclusion criteria; 65.4% were male and the median age was 47. The mean ISS was 11 ± 8.9. Nine hundred seventeen patients (11.1%) died after discharge; 4.8% of patients had hospital-acquired pneumonia (HAP) and 4.2% had a urinary tract infection (UTI). The unadjusted odds ratio (OR) of mortality after discharge in patients who had pneumonia and UTI were 1.77 (1.35, 2.31, p < 0.001) and 2.44 (1.87, 3.17, p < 0.001), respectively. After adjusting for patient age, gender, ISS, ventilator use, and history of COPD (pneumonia patients only), the odds for mortality after discharge remained significant for pneumonia (OR = 1.57 (1.09, 2.23), p = 0.013) but not for UTI (OR = 1.25 (0.93, 1.68), p = 0.147). The top causes of death after discharge in patients with HAP were COPD (11.4%) and falls (7.1%).
Trauma patients with HAP have higher mortality after hospital discharge. Prevention strategies for HAP including pulmonary toilet, early mobility, pain control, and early extubation must be a priority. Unfortunately, patients who develop pneumonia may have a decreased reserve, or ability to recover from their traumatic injuries and HAI. Further characterization of HAP and its subsequent treatment strategies are needed.
创伤患者的医院获得性感染（HAI）会增加住院患者的发病率和死亡率。然而，其对长期死亡率的影响尚不清楚。
对2008年7月1日至2012年12月31日期间入住一级学术创伤中心的所有患者进行回顾性创伤登记分析。纳入患者为存活至出院且年龄在18岁及以上者。记录年龄、性别、损伤严重程度评分（ISS）、呼吸机使用情况、慢性阻塞性肺疾病（COPD）病史及HAI情况。使用姓名、社会保障号码和出生日期从2008 - 2013年国家死亡指数中提取出院后死亡率、死亡时间及死亡原因的数据。进行未调整的逻辑回归分析。采用多因素逻辑回归分析来调整患者和损伤特征，并确定出院后时期的死亡几率。
共有8275例患者符合纳入标准；65.4%为男性，中位年龄为47岁。平均ISS为11±8.9。917例患者（11.1%）出院后死亡；4.8%的患者发生医院获得性肺炎（HAP），4.2%的患者发生尿路感染（UTI）。发生肺炎和UTI的患者出院后死亡的未调整优势比（OR）分别为1.77（1.35，2.31，p<0.001）和2.44（1.87，3.17，p<0.001）。在调整患者年龄、性别、ISS、呼吸机使用情况及COPD病史（仅针对肺炎患者）后，肺炎患者出院后死亡几率仍具有统计学意义（OR = 1.57（1.09，2.23），p = 0.013），而UTI患者则无统计学意义（OR = 1.25（0.93，1.68），p = 0.147）。HAP患者出院后的主要死亡原因是COPD（11.4%）和跌倒（7.1%）。
发生HAP的创伤患者出院后死亡率较高。预防HAP的策略，包括肺部护理、早期活动、疼痛控制和早期拔管，必须作为优先事项。不幸的是，发生肺炎的患者可能储备功能下降，或从创伤性损伤和HAI中恢复的能力降低。需要对HAP及其后续治疗策略进行进一步的特征描述。
