Nosocomial infection in patients with brain trauma

Objective

To determine the incidence of nosocomial infection in critically ill patients with brain trauma.

Methods

A prospective study was performed during 12 months of patients with brain trauma admitted to a 24-bed medical-surgical ICU of a 650-bed university hospital. Infections were diagnosed according to CDC criteria. Infections were classified based on the onset moment as early onset and late onset: early onset (EO) were those developed during the first 4 days of the ICU stay; and late onset (LO) were those developed 5 days after ICU admission. The statistical analysis was performed using the SPSS 11.0 program. Continuous variables are reported as means and standard deviation, and categoric variables as percentages.

Results

We included 67 patients, 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): 27 pneumonias (15 EO and 12 LO; seven MSSA, one MRSA, six Pseudomonas aeruginosa, four Hemophillus influenzae), six urinary tract infections (one EO and five LO; three CNS), two primary bacteremias (one EO and one LO; one CNS and one Acinetobacter), one catheter-related bacteremia (one LO; one Enterobacter), one ventriculitis (one EO; one CNS) and one wound surgical infection (one LO; one Pseudomonas aeruginosa). The microorganisms responsible for nosocomial infections were the following: eight MSSA, one MRSA, seven P. aeruginosa, five CNS, five H. influenzae and 12 others. Death occurred in 14 patients (20.89%).

Conclusion

In our series, 40% of patients developed some infection. Two-thirds of nosocomial infections had a respiratory origin. The most frequent microorganisms were MSSA and P. aeruginosa. One-quarter of patients died.