PNEUMONIA IN INTUBATED TRAUMA PATIENTS - MICROBIOLOGY AND OUTCOMES

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.