OBJECTIVETo explore the risk factors of nosocomial infection in severe craniocerebral trauma and the way of prevention.

METHODSThe clinical data of 387 patients with severe craniocerebral trauma were reviewed.

RESULTSThe total nosocomial infection rate of this study was 22.99%. Pulmonary nosocomial infection presented most frequently. The G-bacilli were the most common infectious bacteria. The mortality rate of the infection group was 38.20%.

CONCLUSIONSComplications of nosocomial infection affect the prognosis of craniocerebral trauma patients. Nosocomial infection is related to the age of the patients, craniocerebral trauma severity, unreasonable utilization of antibiotics and invasive operations, such as tracheal cannula, mechanical ventilation, urethral catheterization and deep venous catheterization. Patients with severe craniocerebral trauma should be carefully treated and nursed to avoid nosocomial infection. In order to reduce the rate of nosocomial infection, intensive measurement should be adopted.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Brain Injuries ; complications ; microbiology ; Child ; Child, Preschool ; Cross Infection ; epidemiology ; microbiology ; prevention & control ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors

BACKGROUND/AIMS: Nosocomial infections caused by multidrug-resistant (MDR) Acinetobacter baumannii have become public-health problem. However, few studies have evaluated the control of endemic MDR A. baumannii in Intensive Care Units (ICUs). Therefore, we investigated the effectiveness of antimicrobial stewardship and comprehensive intensified infection control measures for controlling endemic MDR A. baumannii in ICUs at a tertiary care center. METHODS: Carbapenem use was strictly restricted through antimicrobial stewardship. Environmental cleaning and disinfection was performed at least 3 times per day in addition to basic infection control measures. Isolation using plastic curtains and contact precautions were applied to patients who were colonized or infected with MDR A. baumannii. The outcome was measured as the incidence density rate of hospital-onset MDR A. baumannii among patients in the ICUs. RESULTS: The incidence density rate of hospital-onset MDR A. baumannii decreased from 22.82 cases per 1,000 patient-days to 2.68 cases per 1,000 patient-days after the interventions were implemented (odds ratio, 0.12; 95% confidence interval, 0.03 to 0.4; p < 0.001). The mean monthly use of carbapenems also decreased from 134.99 +/- 82.26 defined daily doses per 1,000 patient-days to 94.85 +/- 50.98 defined daily doses per 1,000 patient-days (p = 0.016). CONCLUSIONS: Concomitant implementation of strict antimicrobial stewardship and comprehensive infection control measures effectively controlled endemic MDR A. baumannii in our ICUs within 1 year.
Acinetobacter Infections/epidemiology/microbiology/*prevention & control/transmission ; Acinetobacter baumannii/*drug effects/pathogenicity ; Anti-Bacterial Agents/adverse effects/*therapeutic use ; Carbapenems/adverse effects/*therapeutic use ; Chi-Square Distribution ; Cross Infection/epidemiology/microbiology/*prevention & control/transmission ; Disinfection ; *Drug Resistance, Multiple, Bacterial ; *Endemic Diseases ; Hand Disinfection ; Humans ; Incidence ; Infection Control/*methods ; Microbial Sensitivity Tests ; Odds Ratio ; Patient Isolation ; Program Evaluation ; Republic of Korea/epidemiology ; Risk Factors ; Tertiary Care Centers ; Time Factors ; Treatment Outcome