Increases in mortality, length of stay, and cost associated with hospital-acquired infections in trauma patients

Department of Anesthesiology, University of Rochester School of Medicine, Rochester, NY 14642, USA.
Archives of surgery (Chicago, Ill.: 1960) (Impact Factor: 4.93). 03/2011; 146(7):794-801. DOI: 10.1001/archsurg.2011.41
Source: PubMed


To explore the clinical impact and economic burden of hospital-acquired infections (HAIs) in trauma patients using a nationally representative database.
Retrospective study.
The Healthcare Cost and Utilization Project Nationwide Inpatient Sample.
Trauma patients.
We examined the association between HAIs (sepsis, pneumonia, Staphylococcus infections, and Clostridium difficile- associated disease) and in-hospital mortality, length of stay, and inpatient costs using logistic regression and generalized linear models.
After controlling for patient demographics, mechanism of injury, injury type, injury severity, and comorbidities, we found that mortality, cost, and length of stay were significantly higher in patients with HAIs compared with patients without HAIs. Patients with sepsis had a nearly 6-fold higher odds of death compared with patients without an HAI (odds ratio, 5.78; 95% confidence interval, 5.03-6.64; P < .001). Patients with other HAIs had a 1.5- to 1.9-fold higher odds of mortality compared with controls (P < .005). Patients with HAIs had costs that were approximately 2- to 2.5-fold higher compared with patients without HAIs (P < .001). The median length of stay was approximately 2-fold higher in patients with HAIs compared with patients without HAIs (P < .001).
Trauma patients with HAIs are at increased risk for mortality, have longer lengths of stay, and incur higher inpatient costs. In light of the preventability of many HAIs and the magnitude of the clinical and economic burden associated with HAIs, policies aiming to decrease the incidence of HAIs may have a potentially large impact on outcomes in injured patients.

Download full-text


Available from: Laurent Glance,
  • Source
    • "Severe trauma predisposes patients to infection with rates as high as 37% of patients [2]. Infectious complications, such as sepsis and pneumonia, increase the length of hospitalization and cost of treatment [3], [4]. Furthermore, infection increases a traumatically injured patient's mortality rate by 5-fold [5]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Severe trauma renders patients susceptible to infection. In sepsis, defective bacterial clearance has been linked to specific deviations in the innate immune response. We hypothesized that innate immune modulations observed during sepsis also contribute to increased bacterial susceptibility after severe trauma. A well-established murine model of burn injury, used to replicate infection following trauma, showed that wound inoculation with P. aeruginosa quickly spreads systemically. The systemic IL-10/IL-12 axis was skewed after burn injury with infection as indicated by a significant elevation in serum IL-10 and polarization of neutrophils into an anti-inflammatory ("N2"; IL-10(+) IL-12(-)) phenotype. Infection with an attenuated P. aeruginosa strain (ΔCyaB) was cleared better than the wildtype strain and was associated with an increased pro-inflammatory neutrophil ("N1"; IL-10(-)IL-12(+)) response in burn mice. This suggests that neutrophil polarization influences bacterial clearance after burn injury. Administration of a TLR5 agonist, flagellin, after burn injury restored the neutrophil response towards a N1 phenotype resulting in an increased clearance of wildtype P. aeruginosa after wound inoculation. This study details specific alterations in innate cell populations after burn injury that contribute to increased susceptibility to bacterial infection. In addition, for the first time, it identifies neutrophil polarization as a therapeutic target for the reversal of bacterial susceptibility after injury.
    PLoS ONE 01/2014; 9(1):e85623. DOI:10.1371/journal.pone.0085623 · 3.23 Impact Factor
  • Source
    • "Patients with HAIs had costs that were approximately 2- to 2.5-fold higher than those of patients without HAIs. The median LOS was approximately 2-fold higher in patients with HAIs than in patients without HAIs.6 For example, results from a population-based data set indicated that mortality and LOS are increased among inflammatory bowel disease patients who develop HAIs. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Health care–associated and hospital-acquired infections are two entities associated with increased morbidity and mortality. They are highly costly and constitute a great burden to the health care system. Vitamin D deficiency (< 20 ng/ml) is prevalent and may be a key contributor to both acute and chronic ill health. Vitamin D deficiency is associated with decreased innate immunity and increased risk for infections. Vitamin D can positively influence a wide variety of microbial infections. Herein we discuss hospital-acquired infections, such as pneumonia, bacteremias, urinary tract and surgical site infections, and the potential role vitamin D may play in ameliorating them. We also discuss how vitamin D might positively influence these infections and help contain health care costs. Pending further studies, we think it is prudent to check vitamin D status at hospital admission and to take immediate steps to address existing insufficient 25-hydroxyvitamin D levels.
    Dermato-Endocrinology 04/2012; 4(2):167-75. DOI:10.4161/derm.20789
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To examine the association between hospital self-reported compliance with the National Quality Forum patient safety practices and trauma outcomes in a nationally representative sample of level I and level II trauma centers. Retrospective cohort study using the Nationwide Inpatient Sample. Level I and level II trauma centers. Trauma patients. Multivariate logistic regression models were estimated to examine the association between clinical outcomes (in-hospital mortality and hospital-associated infections) and the National Quality Forum patient safety practices. We controlled for patient demographic characteristics, injury severity, mechanism of injury, comorbidities, and hospital characteristics. The total score on the Leapfrog Safe Practices Survey was not associated with either mortality (adjusted odds ratio [aOR], 0.92; 95% confidence interval [CI], 0.79-1.06) or hospital-associated infections (1.03; 0.82-1.29). Full implementation of computerized physician order entry was not associated with reduced mortality (aOR, 1.03; 95% CI, 0.75-1.42) or with a lower risk of hospital-associated infections (0.94; 0.57-1.56). Full implementation of intensive care unit physician staffing was also not predictive of mortality (aOR, 1.13; 95% CI, 0.90-1.28) or of hospital-associated infections (1.04; 0.76-1.42). In this nationally representative sample of level I and level II trauma centers, we were unable to detect evidence that hospitals reporting better compliance with the National Quality Forum patient safety practices had lower mortality or a lower incidence of hospital-associated infections.
    Archives of surgery (Chicago, Ill.: 1960) 10/2011; 146(10):1170-7. DOI:10.1001/archsurg.2011.247 · 4.93 Impact Factor
Show more