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Incidence, impact and risk factors for multidrug-resistant organisms (MDRO) in patients with major trauma: a European Multicenter Cohort Study

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Abstract

Introduction

The burden of MDRO in health systems is a global issue, and a growing problem. We conducted a European multicenter cohort study to assess the incidence, impact and risk factors for multidrug-resistant organisms in patients with major trauma. We conducted this study because the predictive factors and effects of MDRO in severely injured patients are not yet described. Our hypothesis is that positive detection of MDRO in severely injured patients is associated with a less favorable outcome.

Methods

Retrospective study of four level-1 trauma centers including all patients after major trauma with an injury severity score (ISS) ≥ 9 admitted to an intensive care unit (ICU) between 2013 and 2017. Outcome was measured using the Glasgow outcome scale (GOS).

Results

Of 4131 included patients, 95 (2.3%) had a positive screening for MDRO. Risk factors for MDRO were male gender (OR 1.73 [95% CI 1.04–2.89]), ISS (OR 1.01 [95% CI 1.00–1.03]), PRBC’s given (OR 1.73 [95% CI 1.09–2.78]), ICU stay > 48 h (OR 4.01 [95% CI 2.06–7.81]) and mechanical ventilation (OR 1.85 [95% CI 1.01–3.38]). A positive MDRO infection correlates with worse outcome. MDRO positive cases GOS: good recovery = 0.6%, moderate disability = 2.1%, severe disability = 5.6%, vegetative state = 5.7% (p < 0.001).

Conclusions

MDRO in severely injured patients are rare but associated with a worse outcome at hospital discharge. We identified potential risk factors for MDRO in severely injured patients. Based on our results, we recommend a standardized screening procedure for major trauma patients.

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Abbreviations

AIS:

Abbreviated injury scale

ASA:

American Society of Anesthesiologists, grading of patients for surgical procedures

CI:

Confidence interval

ESBL:

Extended-spectrum beta-lactamase

GCS:

Glasgow coma scale

GOS:

Glasgow outcome scale

ICU:

Intensive care unit

IQR:

Interquartile range

ISS:

Injury severity score

kPa:

Kilopascal

MAIS3 + :

Maximum abbreviated injury scale 3 + ICU treatment

MDR-GNB:

Multidrug resistant gram-negative bacteria

MDRO:

Multidrug-resistant organisms

mmHg:

Unit millimeters of mercury

MRSA:

Methicillin resistant S. aureus

NS:

No significance

OR:

Odds ratio

PaCO2 :

Partial pressure of arterial carbon dioxide

PRBC:

Packed red blood cells

SD:

Standard deviation

SIRS:

Systemic inflammatory response syndrome

VRE:

Vancomycin resistant Enterococcus spp.

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Acknowledgements

A part of the study results has been presented in 2019 at the European Society of Intensive Care Medicine annual congress.

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Authors and Affiliations

  1. Department of Trauma Surgery, BG Hospital Duisburg, BG Klinikum Duisburg, Grossenbaumer Allee 250, 47249, Duisburg, Germany

    André Nohl & Marcel Dudda

  2. Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany

    Uwe Hamsen & Thomas Armin Schildhauer

  3. Department of Trauma, University Hospital Zurich, Zurich, Switzerland

    Kai Oliver Jensen, Kai Sprengel & Franziska Ziegenhain

  4. Department of Trauma, Hand and Reconstructive Surgery, University Hospital, University Duisburg-Essen, Essen, Germany

    Marcel Dudda

  5. Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany

    Rolf Lefering

  6. Department of Orthopaedics, Trauma and Reconstructive Surgery, Chair of Orthopaedics and Trauma Surgery, St. Marien-Hospital Mülheim a. d. Ruhr, University Duisburg-Essen, Mülheim a.d. Ruhr, Germany

    Alexander Wegner

  7. University of Duisburg-Essen, Essen, Germany

    André Nohl

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Contributions

AN, UH, AW, KOJ were equally responsible for the writing of the manuscript. AN and RL conducted the statistical analysis. UH, AW, KOJ, FZ, KS, RL, MD, TAS participated in the study design and conduct and assisted in the writing of the manuscript. Each author made substantial contributions to the conception or design of the work, the acquisition, analysis or interpretation of data, and drafting and final approval of the manuscript. All authors read and approved and read the final manuscript.

Corresponding author

Correspondence to André Nohl.

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The authors declare that they have no competing interests.

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We received ethics approval and permission by all local ethics committees.

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We obtained consent for publication of de-identified data.

Availability of data and materials

The dataset used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Nohl, A., Hamsen, U., Jensen, K.O. et al. Incidence, impact and risk factors for multidrug-resistant organisms (MDRO) in patients with major trauma: a European Multicenter Cohort Study. Eur J Trauma Emerg Surg 48, 659–665 (2022). https://doi.org/10.1007/s00068-020-01545-4

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