Factors associated with mortality in critically injured trauma patients who require simultaneous cultures

José A. Montalvo, José A. Acosta, Pablo Rodríguez, Christos Hatzigeorgiou, Betzaida González, Alma R. Calderín

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: In trauma patients surviving their initial injuries, infectious complications and multiple organ failure represent the major causes of death after the first 72 hours. Critically injured trauma patients frequently have bacteria recoverable simultaneously from multiple culture sites; the clinical significance of this event is unknown. The objective of this study was to identify the association between growth patterns of multiple site cultures and mortality among critically injured trauma patients. Methods: We performed a retrospective chart review collecting demographic and medical data on admissions to a state-designated Level I trauma center from April 2000 to December 2002. The inclusion criteria were age >17 years, admission to the trauma intensive care unit (TICU), and simultaneous sampling of blood, sputum, and urine in the setting of fever of undetermined origin or alteration in the white blood cell count. Four mutually exclusive groups were developed according to the number of positive culture sites. We used standard statistical analysis and multivariate logistic regression. Results: During the study period, 3,402 patients were admitted to the trauma service of whom 124 met the inclusion criteria. Eighty percent of these (99) were male, and the average age was 41 years. The median TICU stay was 17 days. The mortality rate was 24.2% (30 non-survivors). The survivors and non-survivors were comparable in injury severity score (ISS), initial base deficit, initial hematocrit, initial blood pressure, and hospital length of stay (p > 0.05), whereas age (p = 0.03), female sex (p = 0.04), and TICU stay (p < 0.01) were higher among non-survivors. More non-survivors showed growth of microorganisms in simultaneous blood, sputum, and urine cultures (p = 0.02). By multivariate analysis, adjusting for age, sex, and TICU length of stay, patients with growth of microorganisms in simultaneous cultures (blood, sputum, and urine) had a 3-fold greater mortality rate (OR, 3.20; 95% CI 1.05, 9.73). Conclusions: In this group of patients, growth of bacteria in simultaneous cultures was associated with higher mortality - a factor that may be considered a poor prognostic indicator. This factor requires further studies to explore the relation with survival in critically injured patients.

Original languageEnglish (US)
Pages (from-to)137-142
Number of pages6
JournalSurgical Infections
Volume7
Issue number2
DOIs
StatePublished - Apr 1 2006

Fingerprint

Mortality
Wounds and Injuries
Intensive Care Units
Sputum
Length of Stay
Urine
Growth
Multivariate Analysis
Bacteria
Injury Severity Score
Multiple Organ Failure
Trauma Centers
Leukocyte Count
Hematocrit
Survivors
Cause of Death
Fever
Logistic Models
Demography
Blood Pressure

ASJC Scopus subject areas

  • Surgery
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Factors associated with mortality in critically injured trauma patients who require simultaneous cultures. / Montalvo, José A.; Acosta, José A.; Rodríguez, Pablo; Hatzigeorgiou, Christos; González, Betzaida; Calderín, Alma R.

In: Surgical Infections, Vol. 7, No. 2, 01.04.2006, p. 137-142.

Research output: Contribution to journalArticle

Montalvo, José A. ; Acosta, José A. ; Rodríguez, Pablo ; Hatzigeorgiou, Christos ; González, Betzaida ; Calderín, Alma R. / Factors associated with mortality in critically injured trauma patients who require simultaneous cultures. In: Surgical Infections. 2006 ; Vol. 7, No. 2. pp. 137-142.
@article{5059101cb3674a489876982c1bcdd36f,
title = "Factors associated with mortality in critically injured trauma patients who require simultaneous cultures",
abstract = "Background: In trauma patients surviving their initial injuries, infectious complications and multiple organ failure represent the major causes of death after the first 72 hours. Critically injured trauma patients frequently have bacteria recoverable simultaneously from multiple culture sites; the clinical significance of this event is unknown. The objective of this study was to identify the association between growth patterns of multiple site cultures and mortality among critically injured trauma patients. Methods: We performed a retrospective chart review collecting demographic and medical data on admissions to a state-designated Level I trauma center from April 2000 to December 2002. The inclusion criteria were age >17 years, admission to the trauma intensive care unit (TICU), and simultaneous sampling of blood, sputum, and urine in the setting of fever of undetermined origin or alteration in the white blood cell count. Four mutually exclusive groups were developed according to the number of positive culture sites. We used standard statistical analysis and multivariate logistic regression. Results: During the study period, 3,402 patients were admitted to the trauma service of whom 124 met the inclusion criteria. Eighty percent of these (99) were male, and the average age was 41 years. The median TICU stay was 17 days. The mortality rate was 24.2{\%} (30 non-survivors). The survivors and non-survivors were comparable in injury severity score (ISS), initial base deficit, initial hematocrit, initial blood pressure, and hospital length of stay (p > 0.05), whereas age (p = 0.03), female sex (p = 0.04), and TICU stay (p < 0.01) were higher among non-survivors. More non-survivors showed growth of microorganisms in simultaneous blood, sputum, and urine cultures (p = 0.02). By multivariate analysis, adjusting for age, sex, and TICU length of stay, patients with growth of microorganisms in simultaneous cultures (blood, sputum, and urine) had a 3-fold greater mortality rate (OR, 3.20; 95{\%} CI 1.05, 9.73). Conclusions: In this group of patients, growth of bacteria in simultaneous cultures was associated with higher mortality - a factor that may be considered a poor prognostic indicator. This factor requires further studies to explore the relation with survival in critically injured patients.",
author = "Montalvo, {Jos{\'e} A.} and Acosta, {Jos{\'e} A.} and Pablo Rodr{\'i}guez and Christos Hatzigeorgiou and Betzaida Gonz{\'a}lez and Calder{\'i}n, {Alma R.}",
year = "2006",
month = "4",
day = "1",
doi = "10.1089/sur.2006.7.137",
language = "English (US)",
volume = "7",
pages = "137--142",
journal = "Surgical Infections",
issn = "1096-2964",
publisher = "Mary Ann Liebert Inc.",
number = "2",

}

TY - JOUR

T1 - Factors associated with mortality in critically injured trauma patients who require simultaneous cultures

AU - Montalvo, José A.

AU - Acosta, José A.

AU - Rodríguez, Pablo

AU - Hatzigeorgiou, Christos

AU - González, Betzaida

AU - Calderín, Alma R.

PY - 2006/4/1

Y1 - 2006/4/1

N2 - Background: In trauma patients surviving their initial injuries, infectious complications and multiple organ failure represent the major causes of death after the first 72 hours. Critically injured trauma patients frequently have bacteria recoverable simultaneously from multiple culture sites; the clinical significance of this event is unknown. The objective of this study was to identify the association between growth patterns of multiple site cultures and mortality among critically injured trauma patients. Methods: We performed a retrospective chart review collecting demographic and medical data on admissions to a state-designated Level I trauma center from April 2000 to December 2002. The inclusion criteria were age >17 years, admission to the trauma intensive care unit (TICU), and simultaneous sampling of blood, sputum, and urine in the setting of fever of undetermined origin or alteration in the white blood cell count. Four mutually exclusive groups were developed according to the number of positive culture sites. We used standard statistical analysis and multivariate logistic regression. Results: During the study period, 3,402 patients were admitted to the trauma service of whom 124 met the inclusion criteria. Eighty percent of these (99) were male, and the average age was 41 years. The median TICU stay was 17 days. The mortality rate was 24.2% (30 non-survivors). The survivors and non-survivors were comparable in injury severity score (ISS), initial base deficit, initial hematocrit, initial blood pressure, and hospital length of stay (p > 0.05), whereas age (p = 0.03), female sex (p = 0.04), and TICU stay (p < 0.01) were higher among non-survivors. More non-survivors showed growth of microorganisms in simultaneous blood, sputum, and urine cultures (p = 0.02). By multivariate analysis, adjusting for age, sex, and TICU length of stay, patients with growth of microorganisms in simultaneous cultures (blood, sputum, and urine) had a 3-fold greater mortality rate (OR, 3.20; 95% CI 1.05, 9.73). Conclusions: In this group of patients, growth of bacteria in simultaneous cultures was associated with higher mortality - a factor that may be considered a poor prognostic indicator. This factor requires further studies to explore the relation with survival in critically injured patients.

AB - Background: In trauma patients surviving their initial injuries, infectious complications and multiple organ failure represent the major causes of death after the first 72 hours. Critically injured trauma patients frequently have bacteria recoverable simultaneously from multiple culture sites; the clinical significance of this event is unknown. The objective of this study was to identify the association between growth patterns of multiple site cultures and mortality among critically injured trauma patients. Methods: We performed a retrospective chart review collecting demographic and medical data on admissions to a state-designated Level I trauma center from April 2000 to December 2002. The inclusion criteria were age >17 years, admission to the trauma intensive care unit (TICU), and simultaneous sampling of blood, sputum, and urine in the setting of fever of undetermined origin or alteration in the white blood cell count. Four mutually exclusive groups were developed according to the number of positive culture sites. We used standard statistical analysis and multivariate logistic regression. Results: During the study period, 3,402 patients were admitted to the trauma service of whom 124 met the inclusion criteria. Eighty percent of these (99) were male, and the average age was 41 years. The median TICU stay was 17 days. The mortality rate was 24.2% (30 non-survivors). The survivors and non-survivors were comparable in injury severity score (ISS), initial base deficit, initial hematocrit, initial blood pressure, and hospital length of stay (p > 0.05), whereas age (p = 0.03), female sex (p = 0.04), and TICU stay (p < 0.01) were higher among non-survivors. More non-survivors showed growth of microorganisms in simultaneous blood, sputum, and urine cultures (p = 0.02). By multivariate analysis, adjusting for age, sex, and TICU length of stay, patients with growth of microorganisms in simultaneous cultures (blood, sputum, and urine) had a 3-fold greater mortality rate (OR, 3.20; 95% CI 1.05, 9.73). Conclusions: In this group of patients, growth of bacteria in simultaneous cultures was associated with higher mortality - a factor that may be considered a poor prognostic indicator. This factor requires further studies to explore the relation with survival in critically injured patients.

UR - http://www.scopus.com/inward/record.url?scp=33646688154&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33646688154&partnerID=8YFLogxK

U2 - 10.1089/sur.2006.7.137

DO - 10.1089/sur.2006.7.137

M3 - Article

C2 - 16629603

AN - SCOPUS:33646688154

VL - 7

SP - 137

EP - 142

JO - Surgical Infections

JF - Surgical Infections

SN - 1096-2964

IS - 2

ER -