A Descriptive Review of Bacteremia in Trauma Patients

Author(s):
Arthur Grimes; Ryan Kennedy

Background:

Bacteremia is described as the presence of bacteria in the bloodstream.  This can occur after manipulation of infected tissue, disruption of mucosal or skin barriers, due to persistent endovascular infection, or in the presence of systemic infections.  Bacteremia, when present with sepsis, is associated with increase morbidity and mortality in non-trauma patients.  There is limited literature regarding bacteremia in trauma patients.

Hypothesis:

We describe characteristics, therapy, and outcomes in trauma patients with bacteremia.

Methods:

Bacteremia was defined as positive blood culture. Data was collected over a 5.5 years period from 5/2014 to 4/2019.  Data on patient demographics and clinical characteristic was collected.

Results:

Of the 25,624 trauma patients’ records that were screened for positive blood cultures, 202 patients met the inclusion criteria and were analyzed for the study.  The mean age was 47.4. The mean ISS was 23.2, with majority (73.9%) having an ISS ≥16. 69.8% of patients had positive cultures from non-blood site within 48 hours of positive blood culture primarily (56.9%) from a pulmonary source.  The mean duration of antibiotic therapy was 308.6 hours.  106(52.5%) of patients had SOFA scores ≤ 6. The mean hospital LOS was 29.4 days. The overall mortality was 20.8%.

Conclusions:

This study shows that bacteremia is uncommon in trauma patients.  Frequently it is associated with other sites of infections.  Consideration should be made to tailor duration of antibiotic therapy to sites other than bloodstream infections.  Further studies should assess the need for blood cultures in trauma patients.