W. Campbell et al., Head-injured patients who are nasal carriers of Staphylococcus aureus are at high risk for Staphylococcus aureus pneumonia, CRIT CARE M, 27(4), 1999, pp. 798-801
Objective: To determine if head-injured patients with premorbid nasal colon
ization with Staphylococcus aureus are at increased risk for S. aureus infe
ction,
Design: Patients admitted over a 2-yr period were enrolled if they met the
following criteria: Injury Severity Score greater than or equal to 9, inten
sive care unit (ICU) admission, hospitalization in another hospital <24 hrs
, no recent use of antibiotics,
Setting: Acute care trauma facility,
Patients: Any patient sustaining acute, blunt, or penetrating injury and me
eting the enrollement criteria were eligible.
Interventions: Swab cultures of both internal nares were performed within 7
2 hrs of readmission and cultured for S,Aureus. Patients were prospectively
monitored for S, Aureus infections until discharge,
Measurements and Main Results: Admission nasal cultures were positive (NC+)
for S. aureus in 144 of the 776 patients cultured, Forty of the 144 NC+ pa
tients had isolated head (37) or high cervical spine (3) injury, and 11 of
that group (27.5%) developed S. aureus infections. The remaining 104 patien
ts positive for S, aureus on admission had no head injury (74) or head comb
ined with torso and extremity injuries (30). S. aureus infection was diagno
sed in 11 of the 104 patients (10.6%), The difference in incidence of infec
tions is significant (p <.01), as is the difference in incidence of pneumon
ia (20% vs, 3.8%, respectively [p <01]), Organisms causing pneumonia were o
ften the same organisms isolated from the nares on admission.
Conclusions: Nasal colonization with S. aureus at the time of severe head i
njury increases the risk of S. aureus pneumonia during hospitalization. Pro
phylactic measures against S. aureus pneumonia may help reduce the length a
nd cost of hospitalization.