Fever and Leukocytosis in Critically Ill Trauma Patients: It's Not the Urine
Fever and Leukocytosis in Critically Ill Trauma Patients: It's Not the Urine
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DOI：
10.1089/sur.2007.023
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发表时间：
2008-02-01
影响因子：
2
通讯作者：
Malangoni, Mark A.
中科院分区：
文献类型：
--
作者：
Golob, Joseph F., Jr.;Claridge, Jeffrey A.;Malangoni, Mark A.
背景：感染并发症是创伤危重患者发病和死亡的主要原因。因此，发热和白细胞增多通常会引发广泛的实验室检查，包括尿培养（UCx）。本研究的目的是：1）确定目前在外科和创伤重症监护室（STICU）收治的创伤患者中获得UCx的做法; 2）确定在最初的14个住院日期间发热或白细胞增多与尿路感染（UTIs）之间是否存在关联。对一级创伤中心STICU连续住院至少2天的创伤患者进行了18个月的回顾性队列分析。收集的数据包括前14天的人口统计学、损伤和每日最高温度（T（max））、白细胞计数和UCx结果。发热和白细胞增多分别定义为T（max）≥ 38.5 ℃和白细胞计数≥ 12，000/mm（3）。UCx阳性（>= 10（5）个微生物/mL尿液）可诊断为尿路感染。结果：共对510例患者进行了3，839个患者日的评估。他们的平均年龄和损伤严重程度评分分别为49 +/- 1岁和19 +/- 1分。其中72%为男性，91%为持续性钝性损伤，共获得407个UCx，42名患者（8%）有60个UTI。该队列有97%的患者-天留置导尿管，产生的感染密度为16个UTI/1,000个导尿管-天。获得UCx与发热之间以及发热与白细胞增多之间存在显著相关性（均为p < 0.001），但UTI与发热、白细胞增多或发热与白细胞增多的组合之间无相关性。使用温度和白细胞计数作为连续变量的分析未发现温度或白细胞范围与UTI相关。UTI的独立危险因素，Logistic回归计算女性性别，年龄较大，低损伤严重程度评分，并在24小时内没有抗生素前UCx的gathered.Conclusions：的做法，获得UCx从STICU创伤患者发热和发热与白细胞增多症。然而，发热或白细胞增多或两者均与尿路感染无关。这些数据表明，有一个不必要的强调UTI作为一个来源的发热和白细胞增多的受伤患者在他们的第一个14 STICU天。我们的研究结果表明，评估UTI作为发热原因的范例需要在危重创伤患者中重新评估。
Background: Infectious complications are a major cause of morbidity and mortality in critically ill trauma patients. Therefore, fever and leukocytosis often trigger an extensive laboratory workup that includes a urine culture (UCx). The purposes of this study were to: 1) Define the current practice for obtaining UCxs in trauma patients admitted to the surgical and trauma intensive care unit (STICU); and 2) determine if there is an association between fever or leukocytosis and urinary tract infections (UTIs) during the initial 14 hospital days.Methods: An 18-month retrospective cohort analysis was performed on consecutive trauma patients admitted for at least two days to the STICU at a level I trauma center. Data collected included demographics, injuries, and daily maximal temperature (T(max)), leukocyte count, and UCx results for the first 14 days. Fever and leukocytosis were defined as T(max) >= 38.5 degrees C and leukocyte count >= 12,000/mm(3), respectively. Urinary tract infections were diagnosed with a positive UCx (>= 10(5) organisms/mL of urine).Results: Five hundred ten patients were evaluated for a total of 3,839 patient-days. Their mean age and Injury Severity Score were 49 +/- 1 years and 19 +/- 1 points, respectively. Seventy-two percent were men, and 91% had sustained blunt injuries.Four hundred seven UCxs were obtained; 42 patients (8%) had 60 UTIs. The cohort had an indwelling urinary catheter for 97% of the patient-days, yielding an infection density of 16 UTIs/1,000 urinary catheter-days. There was a significant association between obtaining a UCx and fever and between fever and leukocytosis (both, p < 0.001), but no association of UTI with fever, leukocytosis, or the combination of fever and leukocytosis. Analysis using temperature and leukocyte count as continuous variables identified no temperature or leukocyte range associated with UTIs. Independent risk factors for UTI calculated by logistic regression were female sex, older age, low Injury Severity Score, and no antibiotics within 24 h before the UCx was obtained.Conclusions: The practice of obtaining a UCx from the STICU trauma patient was related to fever and fever with leukocytosis. However, neither fever nor leukocytosis nor both were associated with UTIs. These data suggest that there is an unnecessary emphasis on UTI as a source of fever and leukocytosis in injured patients during their first 14 STICU days. Our results suggest that the paradigm for evaluating UTI as a cause of fever needs to be reevaluated in critically ill trauma patients.