Impact of Device-Associated Infection on Trauma Patient Outcomes at a Major Trauma Center.

Abstract

Catheter-associated urinary tract infection (CAUTI) and ventilator-associated pneumonia (VAP) are considered performance measures. We analyzed the incidence, prevalence, and risk of CAUTI and VAP in trauma patients, as well as the demographic and injury factors related to these infections and their relative risks of negative outcomes (prolonged length of stay [LOS], sepsis, and death). Trauma registry data were analyzed (age >18 y; LOS >24 h) from January 1, 2007, to December 31, 2011. Demographics and injury location, severity, and type were analyzed relative to outcomes along with device-associated infection, as defined by the U.S. Centers for Disease Control and Prevention. The outcomes analyzed were intensive care unit (ICU) and hospital LOS, sepsis, and in-hospital death. Multivariable logistic regression was then used to identify the factors contributing to sepsis, including device-associated infections. The included population (n=10,755) was 66.6% male and had a mean age of 45.1 y, with blunt trauma in 91.8% and a median Injury Severity Score (ISS) of 10 points. Patients developing CAUTI (n=324; 3.0%; p<0.005) were more likely to be female (59.4%), had a higher median ISS (20.5), and were older (56.7 years). Patients with VAP (n=161; 1.5%; p<0.005) had a higher median ISS (27). Patients with sepsis (n=149; 1.4%; p<0.005) had a higher median ISS (24.0) and were older (52.3 y). Sepsis was associated with prolonged LOS and death, as expected (p<0.005). In multivariable analysis, independent predictors of sepsis were CAUTI (odds ratio [OR] 16.15; p<0.001), VAP (OR 6.95; p<0.001), ISS (OR 1.05 per unit; p<0.001), age (OR 1.02 per year; p<0.001), and penetrating, abdominal, pelvic, or chest injury. Development of CAUTI and VAP are significantly associated with a higher risk of sepsis in trauma patients after adjustment for age and injury type, location, and severity. This study suggests the importance of device-associated infections as vectors for sepsis in trauma and highlights the importance of prevention initiatives.