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We examined the effect of an antimicrobial stewardship program (ASP), procalcitonin testing and rapid blood-culture identification on hospital mortality in a prospective quality improvement project in critically ill septic adults. Secondarily, we have reported antimicrobial guideline concordance, acceptance of ASP interventions, and antimicrobial and health-resource utilization.
Traumatic brain injury (TBI) is a leading cause of death and disability. Risk factors for in-hospital mortality include older age, co-morbidity, and TBI severity. Few studies have investigated the role of sepsis in individuals with TBI.
We studied adult patients with TBI admitted to intensive care over a 5-year period. Patient characteristics were identified by linking clinical and administrative databases. Charts of individuals with TBI and sepsis were manually reviewed. Predictors of ICU and hospital mortality were identified using logistic regression modeling.
Four hundred eighty-six individuals with TBI were admitted to intensive care. Sixteen (3.3%) developed sepsis. Pneumonia was the most common source (94%). Staphylococcus aureus was the most common pathogen (75%). ICU lengths of stay (LOS) (12.2 days [interquartile range (IQR) 4.4–23.5] versus 3.7 days [IQR 1.7–8.2]; p < 0.001) and hospital LOS (28.0 days [IQR 11.8–41.4] versus 15.3 days [IQR 5.0–30.9]; p = 0.017) were longer in patients with TBI and sepsis. Sepsis was not associated with ICU (adjusted odds ratio [aOR] 0.51; 95%CI 0.12–2.27; p = 0.38) or hospital (aOR 0.78; 95% CI 0.21–2.96; p = 0.78) mortality, though age (aOR 1.02; 95% CI 1.00–1.04; p = 0.014 for hospital mortality), severe TBI (aOR 3.71; 95% CI 1.52–9.08; p = 0.004 for ICU mortality and 4.10; 95% CI 1.95–8.65; p < 0.001 for hospital mortality), and APACHE II score (aOR 1.19; 95% CI 1.11–1.28; p < 0.001 for ICU mortality and 1.22; 95% CI 1.14–1.31; p < 0.001 for hospital mortality) were.
Sepsis in patients with TBI was not associated with mortality; however, sepsis was associated with increased health care utilization (ICU and hospital LOS).
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