Infectious complications in critically injured children

Purpose: Infection will complicate the care of a significant number of inju red adults. Trauma is the leading cause of mortality in the pediatric popul ation, yet little information is available regarding the incidence of infec tion in this group. This study evaluates infectious complications in the cr itically injured child. Methods: All children admitted to the pediatric intensive care unit from an urban level-1 trauma center during an 80-consecutive-month period were stu died. Infection was defined by Centers for Disease Control criteria and was identified by a retrospective review of the medical records. Demographic a nd clinical information, including microbiologic data, were compiled for al l study patients. Data were analyzed using Student's t test or chi(2) analy sis where appropriate. Results: Five hundred twenty-three children were at risk for infection duri ng the study period. Seventy-eight infections were documented in 53 childre n (incidence, 10.1%). Nosocomial infections accounted for 78% of these with a majority (85%) being device associated. Common infections in this group included lower respiratory (n = 35), primary blood-stream (n = 10), and uri nary tract (n = 7). Trauma-related infections were primarily wound (n = 9), intraabdominal (n = 3), or central nervous system (n = 3). Bacterial patho gens predominated, and the most frequent microorganisms recovered were Stap hylococcus aureus, Pseudomonas sp, and Haemophilus sp, Children with infect ious complications were more severely injured (injury severity score [ISS] 24 versus 17, P < .001) and had a longer hospital stay (21 days V 6 days, P < .001) compared with children without infection during the same period. O verall mortality rate for the study group was 5.7% and was not significantl y different from children without infection. Conclusions: Infection is a significant source of morbidity in the critical ly injured child. Nosocomial infections predominate, and a majority of thes e are device related, emphasizing the need for continued vigilance toward p revention in this high-risk group. J Pediatr Surg 35:1174-1178. Copyright ( C) 2000 by W.B. Saunders Company.