Infectious disease consultation and microbiologic surveillance for intensive care unit trauma patients: A pilot study

Infection remains a major cause of posttrauma morbidity. We retrospectively reviewed 2 cohorts of trauma patients admitted to a regional trauma center before and after a policy change integrating prospective microbiologic sur veillance and infectious disease (ID) consultation into management of traum a admissions. Primary interests were effects of this policy change on antim icrobial use and diagnostic precision (particularly differentiation of infe ction from colonization). Associated costs, microflora, survival, and disab ility were also compared. Patients were stratified for risk of infection. I D consultation was associated with a 49% increased odds that an infection d iagnosis was microbiologically based (P = .006) and 57% reduction of antibi otics costs per hospitalized day (P = .0008). Costs of consultation and an 86% increase (P < 10(-6)) in total cultures combined to minimally exceed th at financial saving. The observed improvements in diagnostic precision and antimicrobial usage, however, suggest consideration of prospective microbio logic surveillance and multidisciplinary physician teams including ID physi cians for high-risk trauma patients.