• Top
• Introduction
• Methods
• Results
• Conclusion
• References

Introduction

Early ventilator-associated pneumonia (VAP) remains the commonest infection in ICUs, in trauma in particular. Controversy exists on whether antibiotic prophylaxis for traumatic lesions increases the respiratory infection rate and antibiotic resistance [1].

Methods

Using the trauma registry and data from the infection surveillance program, we reviewed major trauma cases: admitted consecutively and directly to our unit in 4 years, with a stay longer than 3 days that received no antibiotic at all or received clindamycin-gentamicin from admission for open fractures. Statistical analysis consisted of: Fisher's exact test, Student's t test, multiple logistic regression.

Results

Four hundred and eighty-two patients did not receive antibiotics, 126 did, for 2.8 ± 1.8 days. Groups were not statistically different in age, sex, injury severity score, Glasgow Coma Score (GCS) at admission, prehospital intubation rate, days of artificial ventilation and sedation, surgery, and transfusions. Bivariate analysis of the groups with and without VAP (272 vs 336) showed a statistically significant difference in injury severity score, GCS, days of ventilation, prehospital intubation and antibiotic treatment. Days of ventilation, anatomical severity of trauma and antibiotic treatment were independently associated with VAP in a logistic multivariate model. Antibiotics showed a protective effect against VAP: odds ratio, 0.386; 95% confidence interval, 0.227–0.657. VAP in non-antibiotic treated patients was caused by Staphylococcus aureus in 37.7% (4% methicillin-resistant S. aureus [MRSA]) of cases, haemophilus in 25%, Gram-negative, including pseudomonas, in 25.4%. In patients treated with antibiotics S. aureus was isolated in 17.4% of cases (5.5% MRSA), haemophilus in 30.4%, Gram-negative, including pseudomonas, in 43.1%.

Conclusion

Seventy-two hours of antibiotic therapy for open third-degree fracture is protective against VAP in trauma patients. When VAP occurs after or during antibiotic treatment, isolations shift towards haemophilus, pseudomonas or other Gram-negative germs, not MRSA.

References

1. Hoth JJ: Prophylactic antibiotics adversely affect nosocomial pneumonia in trauma patients.

   J Trauma 2003, 55:249-254. PubMed Abstract | Publisher Full Text

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