Head-injured patients who are nasal carriers of Staphylococcus aureus are at high risk for Staphylococcus aureus pneumonia

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.