Incidence of nosocomial infection in patients with nontraumatic or traumatic coma

Introduction

To determine the rate of nosocomial infection in nontraumatic or traumatic coma patients.

Methods

A prospective study for 24 months in a medical–surgical ICU. Infections were diagnosed according to CDC criteria. Infections were classified based on the diagnosis onset as: early onset (EO), developed during the first 4 days of ICU stay; and late onset (LO), developed 5 days after ICU admission.

Results

We included 118 patients with nontraumatic coma (31 intracerebral hemorrhage, 30 subarachnoid hemorrhage, 15 brain infarction, 12 intoxication, nine CNS infection, six status epilepticus and 15 others), 63 males. The mean age was 55.07 (± 16.12 years). The mean APACHE II score was 18.50 (± 12.02). A total of 47 patients (39.83%) developed 70 nosocomial infections (28 EO and 42 LO) and death in 32 patients (27.12%): 33 pneumonias (18 EO and 15 LO), 25 urinary tract infections (eight EO and 17 LO), five primary bacteremias (two EO and three LO), three catheter-related bacteremias (three LO), three ventriculitis (three LO) and one wound surgical infection (one LO). The microorganisms responsible were: nine Pseudomonas, nine CNS, eight Escherichia coli, six MSSA, five MRSA, five Haemophillus, five Candida albicans, four Streptococcus faecalis, four Streptococcus pneumoniae, four Proteus mirabilis and 11 others. Included were 67 patients with traumatic coma, 57 males. The mean age was 38.02 (± 17.49 years). The mean APACHE II score was 18.32 (± 12.21). A total of 27 patients (40.29%) developed 38 nosocomial infections (18 EO and 20 LO) and death in 14 patients (20.89%): 27 pneumonias (15 EO and 12 LO), six urinary tract infections (one EO and five LO), two primary bacteremias (one EO and one LO), one catheter-related bacteremia (one LO), one ventriculitis (one EO) and one wound surgical infection (one LO). The microorganisms responsible were: eight MSSA, one MRSA, seven Pseudomonas aeruginosa, five CNS, five Haemophillus influenzae and 12 others.

Conclusion

Forty percent of patients with nontraumatic and traumatic coma developed infections – those with a respiratory origin being the most frequent.