Hospital Acquired Infections: Preventable Cause of Mortality in Spinal Cord Injury Patients

Sanjeev Lalwani; Parul Punia; Purva Mathur; Vivek Trikha; Gurudutta Satyarthee; Mahesh C Misra

doi:10.4103/0974-2727.129089

Journal of Laboratory Physicians, Table of Contents

CC BY-NC-ND 4.0 · J Lab Physicians 2014; 6(01): 036-039
DOI: 10.4103/0974-2727.129089

Original Article

Hospital Acquired Infections: Preventable Cause of Mortality in Spinal Cord Injury Patients

Sanjeev Lalwani

Department of Forensic, Jai Prakash Narayan Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

,

Parul Punia

Department of Laboratory Medicine, Jai Prakash Narayan Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

,

Purva Mathur

Department of Laboratory Medicine, Jai Prakash Narayan Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

,

Vivek Trikha

Department of Orthopedics, Jai Prakash Narayan Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

,

Gurudutta Satyarthee

Department of Orthopedics, Jai Prakash Narayan Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

,

Mahesh C Misra

Department of Surgery, Jai Prakash Narayan Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

› Author Affiliations

Abstract

PDF Download

ABSTRACT

Background: There is an alarming rate of morbidity and mortality observed in the trauma victims who suffer spinal cord injuries (SCI). Such patients are admitted immediately and stay for longer periods of time and thus are at risk of acquiring nosocomial infections.

Aims: The aim of this study is to analyze the primary cause of mortality in SCI patients.

Design: Retrospective study.

Materials and Methods: We conducted a retrospective 4 year analysis of the postmortem data of 341 patients who died after sustaining SCI at a tertiary care apex trauma center of India. Epidemiological data of patients including the type of trauma, duration of hospital stay, cause of death and microbiological data were recorded.

Results: On autopsy, out of 341 patients, the main cause of death in the SCI patients was ascertained to be infection/septicemia in 180 (52.7%) patients, the rest 161 (47.2%) died due to severe primary injury. Respiratory tract infections (36.4%) were predominant followed by urinary tract infections (32.2%), blood stream infections (22.2%), wound infections (7.1%) and meningitis reported in only 5 (2.1%) cases. Acinetobacter sp (40%) was the predominant organism isolated, followed by Pseudomonas sp (16.3%), Klebsiella sp (15.1%), Candida sp (7.8%), Escherichia coli (6.9%), Staphylococcus aureus (6.9%), Proteus sp (3.3%), Enterobacter sp and Burkholderia sp (two cases each) and Stenotrophomonas sp (one case). A high level of multidrug resistance was observed.

Conclusions: Hospital acquired infections (HAI) are leading cause of loss of young lives in trauma patients; hence efforts should be made to prevent HAIs.

Key words:

Hospital acquired infections - level of injury - multidrug resistance - respiratory tract infections - spinal cord injury - urinary tract infections

PDF (700 kb)

References

REFERENCES
1 Vasiliadis AV. Epidemiology map of traumatic spinal cord injuries: A global overview. Int J Caring Sci 2012;5:335-47.
2 Hagen EM, Rekand T, Gilhus NE, Grønning M. Traumatic spinal cord injuries: Incidence, mechanisms and course. Tidsskr Nor Laegeforen 2012;132:831-7.
3 Montgomerie JZ. Infections in patients with spinal cord injuries. Clin Infect Dis 1997;25:1285-90;1291.
4 LaVela SL, Evans CT, Miskevics S, Parada JP, Priebe M, Weaver FM. Long-term outcomes from nosocomial infections in persons with spinal cord injuries and disorders. Am J Infect Control 2007;35:393-400.
5 Evans CT, LaVela SL, Weaver FM, Priebe M, Sandford P, Niemiec P, et al. Epidemiology of hospital-acquired infections in veterans with spinal cord injury and disorder. Infect Control Hosp Epidemiol 2008;29:234-42.
6 van den Berg ME, Castellote JM, de Pedro-Cuesta J, Mahillo-Fernandez I. Survival after spinal cord injury: A systematic review. J Neurotrauma 2010;27:1517-28.
7 Singh R, Sharma SC, Mittal R, Sharma A. Taumatic spinal cord injuries in Haryana: An epidemiological study. Indian J Community Med 2003;28:10-2.
8 Thietje R, Pouw MH, Schulz AP, Kienast B, Hirschfeld S. Mortality in patients with traumatic spinal cord injury: Descriptive analysis of 62 deceased subjects. J Spinal Cord Med 2011;34:482-7.
9 Jackson AB, Groomes TE. Incidence of respiratory complications following spinal cord injury. Arch Phys Med Rehabil 1994;75:270-5.
10 Stover SL, Lloyd LK, Waites KB, Jackson AB. Urinary tract infection in spinal cord injury. Arch Phys Med Rehabil 1989;70:47-54.
11 Frankel HL, Coll JR, Charlifue SW, Whiteneck GG, Gardner BP, Jamous MA, et al. Long-term survival in spinal cord injury: A fifty year investigation. Spinal Cord 1998;36:266-74.
12 Chiu WT, Lin HC, Lam C, Chu SF, Chiang YH, Tsai SH. Review paper: Epidemiology of traumatic spinal cord injury: Comparisons between developed and developing countries. Asia Pac J Public Health 2010;22:9-18.
13 Sinha DK. Manual of Patna model for the care of spinal cord injury patients. Patna: SPARSH; 2000. p. 9-13.
14 Karacan I, Koyuncu H, Pekel O, Sümbüloglu G, Kirnap M, Dursun H, et al. Traumatic spinal cord injuries in Turkey: A nation-wide epidemiological study. Spinal Cord 2000;38:697-701.
15 Sommer JL, Witkiewicz PM. The therapeutic challenges of dual diagnosis: TBI/SCI. Brain Inj 2004;18:1297-308.
16 Siegel JD, Rhinehart E, Jackson M, Chiarello L, Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35:S165-93.