HYPOTHESIS: We sought to determine whether the usual risk factors for fungal infections are applied to trauma patients. DESIGN: Case-control study. SETTING: American College of Surgeons Committee on Trauma-certified Level I trauma center in a tertiary care community hospital. PATIENTS: Screening of medical records of a consecutive sample of 459 patients aged 16 years or older admitted to an intensive care unit for 4 days or more from 1993 through 1996 identified 20 patients infected with Candida species. Two case controls for each were selected from the remaining patients using sex, age within 5 years, mechanism of injury, and best fit of first 4 Abbreviated Injury Scale scores; the Injury Severity Score and intensive care unit length of stay were also used if needed. INTERVENTIONS: None. RESULTS: Univariate analyses by t and chi2 tests showed significance (P<.05) for number of units of blood transfused in the first 24 hours after injury, gastrointestinal perforation, hemodialysis, and total parenteral nutrition. Steroids, fungal colonization, use of central venous catheters, Acute Physiology and Chronic Health Evaluation II score, mechanical ventilation for 3 days or more, and the number and duration of antibiotics were not significantly different. Logistic regression analysis showed that only total parenteral nutrition was an independent risk factor in this trauma population. CONCLUSION: Many of the classic risk factors for fungal infection in other populations are actually concomitants of injury severity and its requisite level of care in trauma patients. Hyperalimentation in persistently critically ill trauma patients significantly increases the risk of Candida infection.
HYPOTHESIS: We sought to determine whether the usual risk factors for fungal infections are applied to traumapatients. DESIGN: Case-control study. SETTING: American College of Surgeons Committee on Trauma-certified Level I trauma center in a tertiary care community hospital. PATIENTS: Screening of medical records of a consecutive sample of 459 patients aged 16 years or older admitted to an intensive care unit for 4 days or more from 1993 through 1996 identified 20 patients infected with Candida species. Two case controls for each were selected from the remaining patients using sex, age within 5 years, mechanism of injury, and best fit of first 4 Abbreviated Injury Scale scores; the Injury Severity Score and intensive care unit length of stay were also used if needed. INTERVENTIONS: None. RESULTS: Univariate analyses by t and chi2 tests showed significance (P<.05) for number of units of blood transfused in the first 24 hours after injury, gastrointestinal perforation, hemodialysis, and total parenteral nutrition. Steroids, fungal colonization, use of central venous catheters, Acute Physiology and Chronic Health Evaluation II score, mechanical ventilation for 3 days or more, and the number and duration of antibiotics were not significantly different. Logistic regression analysis showed that only total parenteral nutrition was an independent risk factor in this trauma population. CONCLUSION: Many of the classic risk factors for fungal infection in other populations are actually concomitants of injury severity and its requisite level of care in traumapatients. Hyperalimentation in persistently critically ill traumapatients significantly increases the risk of Candida infection.
Authors: Pierre Emmanuel Charles; Jean Marc Doise; Jean Pierre Quenot; Hervé Aube; Frédéric Dalle; Pascal Chavanet; Nadine Milesi; Ludwig Serge Aho; Henri Portier; Bernard Blettery Journal: Intensive Care Med Date: 2003-09-10 Impact factor: 17.440
Authors: Heimo Wissing; Jose Ballus; Tobias M Bingold; Gonzalo Nocea; Karl J Krobot; Peter Kaskel; Ritesh N Kumar; Panagiotis Mavros Journal: Infect Drug Resist Date: 2013-01-30 Impact factor: 4.003