André Nohl1,2, Uwe Hamsen3, Kai Oliver Jensen4, Kai Sprengel4, Franziska Ziegenhain4, Rolf Lefering5, Marcel Dudda6,7, Thomas Armin Schildhauer3, Alexander Wegner8. 1. Department of Trauma Surgery, BG Hospital Duisburg, BG Klinikum Duisburg, Grossenbaumer Allee 250, 47249, Duisburg, Germany. andre.nohl@bg-klinikum-duisburg.de. 2. University of Duisburg-Essen, Essen, Germany. andre.nohl@bg-klinikum-duisburg.de. 3. Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany. 4. Department of Trauma, University Hospital Zurich, Zurich, Switzerland. 5. Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany. 6. Department of Trauma Surgery, BG Hospital Duisburg, BG Klinikum Duisburg, Grossenbaumer Allee 250, 47249, Duisburg, Germany. 7. Department of Trauma, Hand and Reconstructive Surgery, University Hospital, University Duisburg-Essen, Essen, Germany. 8. Department of Orthopaedics, Trauma and Reconstructive Surgery, Chair of Orthopaedics and Trauma Surgery, St. Marien-Hospital Mülheim a. d. Ruhr, University Duisburg-Essen, Mülheim a.d. Ruhr, Germany.
Abstract
INTRODUCTION: The burden of MDRO in health systems is a global issue, and a growing problem. We conducted a European multicenter cohort study to assess the incidence, impact and risk factors for multidrug-resistant organisms in patients with major trauma. We conducted this study because the predictive factors and effects of MDRO in severely injured patients are not yet described. Our hypothesis is that positive detection of MDRO in severely injured patients is associated with a less favorable outcome. METHODS: Retrospective study of four level-1 trauma centers including all patients after major trauma with an injury severity score (ISS) ≥ 9 admitted to an intensive care unit (ICU) between 2013 and 2017. Outcome was measured using the Glasgow outcome scale (GOS). RESULTS: Of 4131 included patients, 95 (2.3%) had a positive screening for MDRO. Risk factors for MDRO were male gender (OR 1.73 [95% CI 1.04-2.89]), ISS (OR 1.01 [95% CI 1.00-1.03]), PRBC's given (OR 1.73 [95% CI 1.09-2.78]), ICU stay > 48 h (OR 4.01 [95% CI 2.06-7.81]) and mechanical ventilation (OR 1.85 [95% CI 1.01-3.38]). A positive MDRO infection correlates with worse outcome. MDRO positive cases GOS: good recovery = 0.6%, moderate disability = 2.1%, severe disability = 5.6%, vegetative state = 5.7% (p < 0.001). CONCLUSIONS: MDRO in severely injured patients are rare but associated with a worse outcome at hospital discharge. We identified potential risk factors for MDRO in severely injured patients. Based on our results, we recommend a standardized screening procedure for major trauma patients.
INTRODUCTION: The burden of MDRO in health systems is a global issue, and a growing problem. We conducted a European multicenter cohort study to assess the incidence, impact and risk factors for multidrug-resistant organisms in patients with major trauma. We conducted this study because the predictive factors and effects of MDRO in severely injured patients are not yet described. Our hypothesis is that positive detection of MDRO in severely injured patients is associated with a less favorable outcome. METHODS: Retrospective study of four level-1 trauma centers including all patients after major trauma with an injury severity score (ISS) ≥ 9 admitted to an intensive care unit (ICU) between 2013 and 2017. Outcome was measured using the Glasgow outcome scale (GOS). RESULTS: Of 4131 included patients, 95 (2.3%) had a positive screening for MDRO. Risk factors for MDRO were male gender (OR 1.73 [95% CI 1.04-2.89]), ISS (OR 1.01 [95% CI 1.00-1.03]), PRBC's given (OR 1.73 [95% CI 1.09-2.78]), ICU stay > 48 h (OR 4.01 [95% CI 2.06-7.81]) and mechanical ventilation (OR 1.85 [95% CI 1.01-3.38]). A positive MDRO infection correlates with worse outcome. MDRO positive cases GOS: good recovery = 0.6%, moderate disability = 2.1%, severe disability = 5.6%, vegetative state = 5.7% (p < 0.001). CONCLUSIONS: MDRO in severely injured patients are rare but associated with a worse outcome at hospital discharge. We identified potential risk factors for MDRO in severely injured patients. Based on our results, we recommend a standardized screening procedure for major trauma patients.
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