Am. Baker et al., PNEUMONIA IN INTUBATED TRAUMA PATIENTS - MICROBIOLOGY AND OUTCOMES, American journal of respiratory and critical care medicine, 153(1), 1996, pp. 343-349
Citations number
35
Categorie Soggetti
Emergency Medicine & Critical Care","Respiratory System
To describe the epidemiology of nosocomial pneumonia in trauma patient
s and its impact on outcome, we performed a retrospective case-control
analysis. Quantitative bronchoscopic cultures were collected from 62
intubated patients with suspected pneumonia. Patients with proven pneu
monia had higher abdominal injury scores. Those with bronchoscopy-nega
tive pneumonitis were older. Age and injury severity were used to matc
h two controls to each case. The incidence of pneumonia was 5.8%. Stre
ptococci and Hemophilus were common pathogens, but gram-negative rods
were isolated more frequently after lengthier intubation. Polymicrobia
l infections were common. There were no serious complications of bronc
hoscopy, and culture results often led to antibiotic therapy. No exces
s mortality could be attributed to pneumonia. Patients with pneumonia
and those with bronchoscopy-negative pneumonitis required prolonged ca
re compared with others (p < 0.05). Patients with pneumonia did not re
ceive excess ventilation or hospitalization but incurred hospital char
ges 1.5 times higher than controls (p = 0.04). Pneumonia was confirmed
in less than half of those suspected of having it on the basis of cli
nical findings. When severity of injury was considered, pneumonia was
associated with neither increased mortality nor increased hospital car
e, but the clinical features suggesting respiratory infection identifi
ed trauma patients requiring prolonged hospitalization and incurring h
igher costs.