Influence of Antibiotic Management on Microbial Selection and Infectious Complications After Trauma

Background: The inflammatory response and post-traumatic complications like infections play an important role in the pathophysiology of severe injuries. This study examines the microbiological aspects in anti-infective treatment of trauma patients and their inflammatory response in post-traumatic infections complications.Patients and Methods: A retrospective analysis of prospectively collected data in trauma patients (ISS ≥ 16) over a 1-year period (01/2018 to 12/2018) is provided. Patient population was stratified into severely injured patients without post-traumatic infection (inf-PT), and severely injured patients who developed an infection (inf+PT).Results: Of 114 trauma patients, 45 suffered from post-traumatic infection during the first 10 days of hospitalization. Severely injured patients with concomitant traumatic brain injury (PT+TBI) showed the highest rate of post-traumatic infection. Pro-inflammatory reaction was tracked by levels of Interleukin (IL-)6 (day 3: inf+T 190.8 ± 359.4 pg/dL > inf-PT 56.2 ± 57.7 pg/mL (mean ± SD); p = 0.008) and C-Reactive-Protein (CRP, day 3: inf+PT 15.3 mg/dL > inf-PT 6.7 mg/dL, p = 0.001) which were significantly higher in trauma patients who develop an infectious complication and showed a significant positive correlation with the occurrence of infection. The leading entity of infection was pneumonia followed by infections of the urinary tract mainly caused by gram-negative Enterobacteriaceae. 67.5% of all trauma patients received single-shot antibiosis during initial care in trauma bay. The development of secondary colonization was not relevant positively correlated with single-shot antibiosis (r = 0.013, p = 0.895) and prophylactically calculated antibiotic administration (r = 0.066, p = 0.500).Conclusion: Severely injured trauma patients have an increased risk for development of infectious complications, which mainly is pneumonia followed by infection of the urinary tract mainly caused by gram-negative Enterobacteriaceae. Based on the data in this study, the one-time antibiotic and prophylactic calculated use of antibiotics, like Cephalosporins must be critically discussed in terms of their role in the development of post-traumatic infections and microbial selection.

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Neutrophil Gelatinase-associated Lipocalin Predicts Post-traumatic Acute Kidney Injury in Severely Injured Patients

In Vivo ◽

10.21873/invivo.12560 ◽

2021 ◽

Vol 35 (5) ◽

pp. 2755-2762

Author(s):

KATHARINA LEDITZKE ◽

MAXIMILIAN EBERHARD HERMANN WAGNER ◽

CLAUDIA NEUNABER ◽

JAN-DIERK CLAUSEN ◽

MARCEL WINKELMANN

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Severely Injured ◽

Severely Injured Patients ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Post Traumatic ◽

Neutrophil Gelatinase ◽

Injured Patients

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Trauma in pregnancy: A review of the Pennsylvania Trauma Systems Foundation database

Trauma ◽

10.1177/1460408617703677 ◽

2017 ◽

Vol 20 (1) ◽

pp. 30-37 ◽

Cited By ~ 3

Author(s):

Meike Schuster ◽

Natasha Becker ◽

Amanda Young ◽

Michael J Paglia ◽

A Dhanya Mackeen

Keyword(s):

Blunt Trauma ◽

Motor Vehicle ◽

Penetrating Trauma ◽

Blunt Injury ◽

Trauma Patients ◽

Severely Injured ◽

Trauma Systems ◽

Severely Injured Patients ◽

Vaginal Deliveries ◽

Injured Patients

Objective The goal of this study is to determine if injury severity score (ISS) of ≥9 and systolic blood pressure (SBP) predict poor maternal/pregnancy outcomes in blunt and penetrating trauma, respectively. Methods The Pennsylvania Trauma Systems Foundation database was used to identify pregnant trauma patients. Blunt trauma patients were analyzed with regard to ISS, while penetrating trauma patients were analyzed to determine whether SBP < 90 mmHg was predictive of poor maternal outcome. Results Patients with severe blunt injury (ISS ≥ 9) due to motor vehicle accident were less likely to wear seatbelts (51% vs. 63%, p = 0.005), and delivery was required in 17% of these patients as compared to 6% of the less severely injured, and only 6% of those were vaginal deliveries. Severely injured patients were discharged home 68% of the time and 6% died compared to less severely injured patients of which 83% were discharged home and <1% died; all other patients required discharge to a rehabilitation facility. Patients with penetrating trauma and SBP < 90 mmHg on arrival were more likely to require delivery (35% vs. 5%, p < 0.001) and were 14 times more likely to die (58% vs. 4%, p < 0.001) when compared to the normotensive group. Conclusion ISS ≥ 9 and SBP < 90 mmHg are predictors for poor outcomes after trauma during pregnancy. Severely injured blunt trauma patients often require surgery and delivery. Patients who present with SBP < 90 after penetrating trauma are more likely to deliver and are 14 times more likely to die.

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Delays in Transfer of Elderly Less-injured Trauma Patients Can Have Deadly Consequences

The American Surgeon ◽

10.1177/000313481408001130 ◽

2014 ◽

Vol 80 (11) ◽

pp. 1132-1135 ◽

Cited By ~ 4

Author(s):

Peter E. Fischer ◽

Paul D. Colavita ◽

Gregory P. Fleming ◽

Toan T. Huynh ◽

A. Britton Christmas ◽

...

Keyword(s):

Trauma Center ◽

Injury Severity ◽

Trauma Patients ◽

Severely Injured ◽

Severely Injured Patients ◽

Local Trauma ◽

Level 1 ◽

Poor Outcomes ◽

Injured Patients ◽

Level 1 Trauma Center

Transfer of severely injured patients to regional trauma centers is often expedited; however, transfer of less-injured, older patients may not evoke the same urgency. We examined referring hospitals’ length of stay (LOS) and compared the subsequent outcomes in less-injured transfer patients (TP) with patients presenting directly (DP) to the trauma center. We reviewed the medical records of less-injured (Injury Severity Score [ISS] 9 or less), older (age older than 60 years) patients transferred to a regional Level 1 trauma center to determine the referring facility LOS, demographics, and injury information. Outcomes of the TP were then compared with similarly injured DP using local trauma registry data. In 2011, there were 1657 transfers; the referring facility LOS averaged greater than 3 hours. In the less-injured patients (ISS 9 or less), the average referring facility LOS was 3 hours 20 minutes compared with 2 hours 24 minutes in more severely injured patients (ISS 25 or greater, P < 0.05). The mortality was significantly lower in the DP patients (5.8% TP vs 2.6% DP, P = 0.035). Delays in transfer of less-injured, older trauma patients can result in poor outcomes including increased mortality. Geographic challenges do not allow for every patient to be transported directly to a trauma center. As a result, we propose further outreach efforts to identify potential causes for delay and to promote compliance with regional referral guidelines.

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Loss of GPVI and GPIbα contributes to trauma-induced platelet dysfunction in severely injured patients

Blood Advances ◽

10.1182/bloodadvances.2020001776 ◽

2020 ◽

Vol 4 (12) ◽

pp. 2623-2630 ◽

Cited By ~ 1

Author(s):

Paul Vulliamy ◽

Samantha J. Montague ◽

Scarlett Gillespie ◽

Melissa V. Chan ◽

Lucy A. Coupland ◽

...

Keyword(s):

Patient Characteristics ◽

Surface Expression ◽

Trauma Patients ◽

Severely Injured ◽

Platelet Dysfunction ◽

Severely Injured Patients ◽

Severe Injuries ◽

Glycoprotein Vi ◽

Active Hemorrhage ◽

Injured Patients

Abstract Trauma-induced coagulopathy (TIC) is a complex, multifactorial failure of hemostasis that occurs in 25% of severely injured patients and results in a fourfold higher mortality. However, the role of platelets in this state remains poorly understood. We set out to identify molecular changes that may underpin platelet dysfunction after major injury and to determine how they relate to coagulopathy and outcome. We performed a range of hemostatic and platelet-specific studies in blood samples obtained from critically injured patients within 2 hours of injury and collected prospective data on patient characteristics and clinical outcomes. We observed that, although platelet counts were preserved above critical levels, circulating platelets sampled from trauma patients exhibited a profoundly reduced response to both collagen and the selective glycoprotein VI (GPVI) agonist collagen-related peptide, compared with those from healthy volunteers. These responses correlated closely with overall clot strength and mortality. Surface expression of the collagen receptors GPIbα and GPVI was reduced on circulating platelets in trauma patients, with increased levels of the shed ectodomain fragment of GPVI detectable in plasma. Levels of shed GPVI were highest in patients with more severe injuries and TIC. Collectively, these observations demonstrate that platelets experience a loss of GPVI and GPIbα after severe injury and translate into a reduction in the responsiveness of platelets during active hemorrhage. In turn, they are associated with reduced hemostatic competence and increased mortality. Targeting proteolytic shedding of platelet receptors is a potential therapeutic strategy for maintaining hemostatic competence in bleeding and improving the efficacy of platelet transfusions.

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Severity of injury does not have any impact on post traumatic stress symptoms in severely injured patients

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/1757-7241-17-s3-o1 ◽

2009 ◽

Vol 17 (Suppl 3) ◽

pp. O1

Author(s):

Anette Quale ◽

Anne Schanke ◽

Kathrine Frøslie ◽

Olav Røise

Keyword(s):

Traumatic Stress ◽

Severely Injured ◽

Post Traumatic Stress ◽

Severely Injured Patients ◽

Stress Symptoms ◽

Severity Of Injury ◽

Post Traumatic ◽

Injured Patients

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Influence of late fluid management on the outcomes of severe trauma patients: A retrospective analysis of 294 severely-injured patients

Injury ◽

10.1016/j.injury.2017.06.005 ◽

2017 ◽

Vol 48 (9) ◽

pp. 1964-1971 ◽

Cited By ~ 4

Author(s):

Mehdi Mezidi ◽

Mehdi Ould-Chikh ◽

Pauline Deras ◽

Camille Maury ◽

Orianne Martinez ◽

...

Keyword(s):

Retrospective Analysis ◽

Fluid Management ◽

Severe Trauma ◽

Trauma Patients ◽

Severely Injured ◽

Severely Injured Patients ◽

Injured Patients

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Malnutrition and its effects in severely injured trauma patients

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01304-5 ◽

2020 ◽

Vol 46 (5) ◽

pp. 993-1004 ◽

Cited By ~ 2

Author(s):

Suzan Dijkink ◽

Karien Meier ◽

Pieta Krijnen ◽

D. Dante Yeh ◽

George C. Velmahos ◽

...

Keyword(s):

Nutritional Status ◽

Adverse Outcomes ◽

Hospital Length Of Stay ◽

Geriatric Trauma ◽

Trauma Patients ◽

Severely Injured ◽

Severely Injured Patients ◽

Trauma Population ◽

Injured Patients

Abstract Purpose In hospitalized patients, malnutrition is associated with adverse outcomes. However, the consequences of malnutrition in trauma patients are still poorly understood. This study aims to review the current knowledge about the pathophysiology, prevalence, and effects of malnutrition in severely injured patients. Methods A systematic literature review in PubMed and Embase was conducted according to PRISMA-guidelines. Results Nine review articles discussed the hypermetabolic state in severely injured patients in relation to malnutrition. In these patients, malnutrition negatively influenced the metabolic response, and vice versa, thereby rendering them susceptible to adverse outcomes and further deterioration of nutritional status. Thirteen cohort studies reported on prevalences of malnutrition in severely injured patients; ten reported clinical outcomes. In severely injured patients, the prevalence of malnutrition ranged from 7 to 76%, depending upon setting, population, and nutritional assessment tool used. In the geriatric trauma population, 7–62.5% were malnourished at admission and 35.6–60% were at risk for malnutrition. Malnutrition was an independent risk factor for complications, mortality, prolonged hospital length of stay, and declined quality of life. Conclusions Despite widespread belief about the importance of nutrition in severely injured patients, the quantity and quality of available evidence is surprisingly sparse, frequently of low-quality, and outdated. Based on the malnutrition-associated adverse outcomes, the nutritional status of trauma patients should be routinely and carefully monitored. Trials are required to better define the optimal nutritional treatment of trauma patients, but a standardized data dictionary and reasonable outcome measures are required for meaningful interpretation and application of results.

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Strategies for the treatment of femoral fractures in severely injured patients: trends in over two decades from the TraumaRegister DGU®

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01599-4 ◽

2021 ◽

Author(s):

Felix M. Bläsius ◽

◽

Markus Laubach ◽

Hagen Andruszkow ◽

Philipp Lichte ◽

...

Keyword(s):

Surgical Treatment ◽

Survival Rates ◽

Treatment Strategies ◽

Femoral Fractures ◽

High Energy ◽

Trauma Patients ◽

Severely Injured ◽

Severely Injured Patients ◽

Femur Fractures ◽

Injured Patients

Abstract Purpose Treatment strategies for femoral fracture stabilisation are well known to have a significant impact on the patient’s outcome. Therefore, the optimal choices for both the type of initial fracture stabilisation (external fixation/EF, early total care/ETC, conservative treatment/TC) and the best time point for conversion from temporary to definitive fixation are challenging factors. Patients Patients aged ≥ 16 years with moderate and severe trauma documented in the TraumaRegister DGU® between 2002 and 2018 were retrospectively analysed. Demographics, ISS, surgical treatment strategy (ETC vs. EF vs. TC), time for conversion to definitive care, complication (MOF, sepsis) and survival rates were analysed. Results In total, 13,091 trauma patients were included. EF patients more often sustained high-energy trauma (car: 43.1 vs. 29.5%, p < 0.001), were younger (40.6 vs. 48.1 years, p < 0.001), were more severely injured (ISS 25.4 vs. 19.1 pts., p < 0.001), and had higher sepsis (11.8 vs. 5.4%, p < 0.001) and MOF rates (33.1 vs. 16.0%, p < 0.001) compared to ETC patients. A shift from ETC to EF was observed. The time until conversion decreased for femoral fractures from 9 to 8 days within the observation period. Sepsis incidences decreased in EF (20.3 to 12.3%, p < 0.001) and ETC (9.1–4.8%, p < 0.001) patients. Conclusions Our results show the changes in the surgical treatment of severely injured patients with femur fractures over a period of almost two decades caused by the introduction of modern surgical strategies (e.g., Safe Definitive Surgery). It remains unclear which subgroups of trauma patients benefit most from these strategies.

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