Dhillon Navpreet K, Tseng Joshua, Barmparas Galinos, Harada Megan Y, Ko Ara, Smith Eric J T, Thomsen Gretchen M, Ley Eric J
Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
J Surg Res. 2018 Apr;224:140-145. doi: 10.1016/j.jss.2017.11.031. Epub 2017 Dec 28.
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in the United States, especially in the elderly, who have the highest rates of TBI-related hospitalizations and deaths among all age groups. Sepsis is one of many risk factors that is associated with higher mortality and longer length of hospital stay in this population partially due to the immunosuppressive effects of TBI. The significance of early indicators of infection, such as a positive blood, sputum, or urine culture, is not well described. The purpose of this study was to determine if early positive cultures predict higher mortality in elderly patients with TBI.
All trauma patients aged ≥65 years with TBI, admitted between January 1, 2009 and December 31, 2013 to the surgical intensive care unit, were retrospectively reviewed. Clinical data including results from sputum, blood, and urine cultures were reviewed.
Overall, 288 elderly patients with TBI were identified, and 92 (32%) had a positive culture. Patients with positive cultures had longer intensive care unit (median 6.0 versus 2.0 days, P < 0.001) and ventilation days (median 7.0 versus 2.0 days, P < 0.001). Patients who had positive cultures within 2-3 days of admission had a higher adjusted hazard ratio for mortality than those patients who had positive cultures after 6 or more days.
In elderly patients with TBI, early positive cultures are associated with a higher risk of mortality. Further research is required to determine the role of obtaining cultures on admission in this subpopulation of trauma patients.
创伤性脑损伤（TBI）是美国发病和死亡的主要原因之一，尤其是在老年人中，他们在所有年龄组中TBI相关住院率和死亡率最高。脓毒症是与该人群较高死亡率和较长住院时间相关的众多风险因素之一，部分原因是TBI的免疫抑制作用。感染早期指标的意义，如血培养、痰培养或尿培养阳性，尚未得到充分描述。本研究的目的是确定早期培养阳性是否能预测老年TBI患者的更高死亡率。
回顾性分析2009年1月1日至2013年12月31日期间入住外科重症监护病房的所有年龄≥65岁的TBI创伤患者。回顾临床数据，包括痰、血和尿培养结果。
总体而言，共识别出288例老年TBI患者，其中92例（32%）培养阳性。培养阳性的患者重症监护病房住院时间更长（中位数6.0天对2.0天，P<0.001），通气时间更长（中位数7.0天对2.0天，P<0.001）。入院后2 - 3天内培养阳性的患者比入院6天或更久后培养阳性的患者调整后的死亡风险更高。
在老年TBI患者中，早期培养阳性与更高的死亡风险相关。需要进一步研究以确定在该创伤患者亚组中入院时进行培养的作用。
