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Head-injured patients who are nasal carriers of Staphylococcus aureus are at high risk for Staphylococcus aureus pneumonia

Campbell, Wayne MD; Hendrix, Elizabeth BA; Schwalbe, Richard PhD; Fattom, Ali PhD; Edelman, Robert MD

Neurologic Critical Care

Objective To determine if head-injured patients with premorbid nasal colonization with Staphylococcus aureus are at increased risk for S. aureus infection.

Design Patients admitted over a 2-yr period were enrolled if they met the following criteria: Injury Severity Score >or=to9, intensive care unit (ICU) admission, hospitalization in another hospital <24 hrs, no recent use of antibiotics.

Setting Acute care trauma facility.

Patients Any patient sustaining acute, blunt, or penetrating injury and meeting the enrollement criteria were eligible.

Interventions Swab cultures of both internal nares were performed within 72 hrs of readmission and cultured for S. Aureus. Patients were prospectively monitored for S. Aureus infections until discharge.

Measurements and Main Results Admission nasal cultures were positive (NC+) for S. aureus in 144 of the 776 patients cultured. Forty of the 144 NC+ patients had isolated head (37) or high cervical spine (3) injury, and 11 of that group (27.5%) developed S. aureus infections. The remaining 104 patients positive for S. aureus on admission had no head injury (74) or head combined with torso and extremity injuries (30). S. aureus infection was diagnosed in 11 of the 104 patients (10.6%). The difference in incidence of infections is significant (p < .01), as is the difference in incidence of pneumonia (20% vs. 3.8%, respectively [p < .01]). Organisms causing pneumonia were often the same organisms isolated from the nares on admission.

Conclusions Nasal colonization with S. aureus at the time of severe head injury increases the risk of S. aureus pneumonia during hospitalization. Prophylactic measures against S. aureus pneumonia may help reduce the length and cost of hospitalization.

(Crit Care Med 1999; 27:798-801)

From the Division of Infectious Diseases, R. Adams Cowley Shock Trauma Center (Dr. Campbell and Ms. Hendrix), the Department of Pathology (Dr. Schwalbe), and Geographic Medicine (Dr. Edelman), University of Maryland School of Medicine, Baltimore, MD; and NABI, (Dr. Fattom) Rockville, MD.

Supported, in part, by a grant from Maryland Industrial Partnerships, University of Maryland, College Park, MD.

© 1999 Lippincott Williams & Wilkins, Inc.