|Year : 2013 | Volume
| Issue : 4 | Page : 390-391
Mortality due to septicemia at a level 1 Indian trauma care centre: An epidemiological analysis
S Lalwani1, P Mathur2, V Tak2, MC Misra3
1 Department of Forensic Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
2 Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
3 Department of Surgical Discipline, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
|Date of Submission||04-Apr-2013|
|Date of Acceptance||28-Aug-2013|
|Date of Web Publication||25-Sep-2013|
Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
Trauma contributes to a significant proportion of mortality and morbidity in the economically productive age group of 15-45 years. Infections are the second most important cause of death in trauma patients after head injury. Despite advances in trauma care, deaths due to septicemia are increasing. An epidemiological study of septicemia-related deaths were conducted at a level 1 Trauma Centre from January 2011 to December 2011. A total of 201 patients died due to suspected septicemia. The average age of the deceased trauma victims was 35.9 years and the median length of stay in hospital before death was 27 days. In our study, a high proportion of patients had grown pathogens in significant counts from respiratory specimens (36%) and blood (23%) during ante-mortem period, which may have contributed to their fatal outcome. Infections are one of the most common and fatal complications following trauma and complicate the recovery of a significant number of injured patients.
Keywords: Autopsy, infections, intensive care unit, mortality, septicemia, trauma
|How to cite this article:|
Lalwani S, Mathur P, Tak V, Misra M C. Mortality due to septicemia at a level 1 Indian trauma care centre: An epidemiological analysis. Indian J Med Microbiol 2013;31:390-1
|How to cite this URL:|
Lalwani S, Mathur P, Tak V, Misra M C. Mortality due to septicemia at a level 1 Indian trauma care centre: An epidemiological analysis. Indian J Med Microbiol [serial online] 2013 [cited 2015 Jul 31];31:390-1. Available from: http://www.ijmm.org/text.asp?2013/31/4/390/118904
| ~ Introduction|| |
Trauma contributes to a significant proportion of mortality and morbidity in the economically productive age group of 15-45 years. , Trauma victims are usually middle-aged males in their economically productive age.  Immediate mortality in trauma patients is usually due to trauma-related factors viz. head injury and haemorrhage while infections are the main contributors of fatality in patients who survive the initial 5 days of trauma. ,, This is due to the critical condition of the patients, who are on multiple invasive devices, which acts as a nidus for infections.  These may be inserted in emergency, often neglecting aseptic precautions. Because most of the trauma victims are young adults, there is a great concern to save them. The management of immediate post-trauma complications like haemorrhage, circulatory collapse and respiratory failure has greatly improved with the application of sophisticated technical advancements.  However, traumatised patients with infections have a five-fold higher mortality compared to those without infection.  Despite advances in trauma care, deaths due to septicemia are increasing. We conducted a 1-year study to understand the epidemiology of septicemia-related death at a level-1 trauma centre of India.
| ~ Materials and Methods|| |
The study was conducted at the Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, from January to December 2011. The study involved trauma victims who were admitted to the intensive care units (ICU) for at least 48 hours prior to death and who had septicemia as a cause of death at autopsy. The autopsy was done as per standard protocols. 
We reviewed the hospital records of all these patients. The detailed post-trauma admission history was recorded for each case. In particular, the following variables were recorded: Type of trauma, duration of hospital stay, associated complications and surgeries performed, culture reports and cause of death. We have an intensive automated surveillance system, with six full-time Hospital Infection Control nurses for our 152-bedded Centre.  A designated healthcare infection control nurse for each ICU and wards fills up a performa for each patient when the length of stay exceeds 48 hours. All the details are entered onto the software, therefore, the clinical, demographic and culture results of all the patients were retrieved using this software.
The antemortem culture results of all these patients were retrieved and the culture results of the period of one week preceding death were recorded. As a policy, we receive tracheal aspirates on Mondays and Thursdays from all admitted ICU patients. In a few patients, bronchoscopic alveolar lavage (BAL) is sent for culture. Two sets of blood cultures are sent in Bac T Alert bottles by clinicians for work-up of fever as per their clinical judgement. Samples of wound/cerebrospinal fluid (CSF) and other sites are also sent as per standard diagnostic protocols, based on the clinical suspicion of the treating physicians. The processing and reporting of samples is done as per standard microbiological methods. ,
| ~ Results|| |
A total of 201 patients died due to suspected septicemia. Of these, 110 had head injury, 37 had spinal injury, 14 had abdominal injury, five had chest injury, six had pelvic injuries, four had injury of head and spine, four had injury of head and chest, three had injury of head and pelvis and one each had injuries of chest with abdomen and head with abdomen. A total of 16 patients had multiple injuries. Of the 201 patients, 167 (83%) were males, which matches the higher proportion of males being admitted. The age of the patients ranged from 9 months to 88 years (average 35.7 years). The length of stay of the cases included in this study ranged from 4 days to 188 days (average 27 days).
Of the 201 patients included in the study, antemortem BAL/tracheal aspirates of 73 (36%) patients had grown significant counts of pathogens within 4 days prior to their fatal outcome. Similarly, blood, CSF, wound sample, urine of 47 (23%), 7 (3%), 21 (10%) and 56 (27.8%) patients had grown a pathogen. [Table 1] shows the pathogens isolated from infections.
|Table 1: Pathogenic organisms isolated from various ante‑mortem infectious samples from the deceased trauma patients in our study population|
Click here to view
| ~ Discussion|| |
Infections are one of the most common and fatal complications following trauma and complicate the recovery of a significant number of injured patients. In our study, of the fatal cases of septicemia, a high proportion of patients had grown pathogens in significant counts from respiratory specimens and blood, which may have contributed to their fatal outcome.
Thus, despite advances in the immediate post-trauma care, the mortality after trauma due to infections remains high. Since trauma patients are predominantly middle aged, efforts to prevent infections in this vulnerable but growing population should be augmented.
| ~ References|| |
|1.||Pories SE, Gamelli RL, Mead PB, Goodwin G, Harris F, Vacek P. The epidemiologic features of nosocomial infections in patients with trauma. Arch Surg 1991;126:97-9. |
|2.||Caplan ES, Hoyt NJ. Identification and treatment of infections in multiply traumatized patients. Am J Med 1985;79:68-76. |
|3.||Mathur P. Infection in traumatized patients: A growing medico-surgical concern. Indian J Med Microbiol 2008;26:212-6. |
|4.||Patel JC, Mollitt DL, Tepas JJ 3 rd . Infectious complications in critically injured children. J Pediatr Surg 2000;35:1174-8. |
|5.||Vij K. Textbook of Forensic Medicine and Toxicology, 4 th ed. New Delhi: India; Elsevier; 2008. |
|6.||Gunjiyal J, Thomas SM, Gupta AK, Sharma BS, Mathur P, Gupta B, et al. Device associated and multidrug-resistant infections in critically ill trauma patients: Towards development of automated surveillance in developing countries. J Hosp Infect 2011;77:176-7. |
|7.||Collee JG, Diguid JP, Fraser AG. In: Mackie and Mc Cartney Practical Medical Microbiology, 14 th ed. Edinburgh: Churchill Livingstone; 1996. |
|8.||Forbes BA, Sahun DF, Weissfeld AS. In: Bailey and Scott's Diagnostic Microbiology, 10 th ed. St. Louis: Mosby; 1998. |