Incidence of and risk factors for nosocomial pneumonia in patients with tetanus

From June 1998 through July 2000, 28 patients with tetanus admitted to the Intensive Care Unit for Tetanus and Infectious Diseases at the Hospital das Clinicas of University of Medicine at Sao Paulo, Brazil, were evaluated to establish what the incidence of nosocomial pneumonia was and what their ri sk factors were. The degree of severity of tetanus was assessed in all pati ents by means of APACHE II scores. The mortality rate was 3.6%. There were 63 hospital infections in 20 patients; among these, there were 10 cases of nosocomial pneumonia in 8 patients. Nosocomial pneumonia was associated in univariate analysis with the degree of severity of tetanus, dysautonomy, us e of neuromuscular blockers, use of higher doses of diazepam, and lower art erial oxygen and oxygen fractions. In the multiple logistical regression, s ignificance was found for dysautonomy (relative risk, 31.67; 95% confidence interval, 2.68-373.74; P = .006). Dysautonomy was an independent risk fact or for pneumonia in patients with tetanus.