Rates and severity of Clostridium difficile infection (CDI) and methicillin-resistant staphylococcus aureus (MRSA) colonization have increased. We sought to explore if the traditional predictors of mortality in trauma patients affected risk of CDI.
We reviewed the last 5 years in our trauma registry. All patients with Injury Severity Score (ISS) > 15 and at least 1 day in the surgical intensive care unit (SICU) were reviewed for development of CDI. MRSA screening by nasal swab was only done in the last year.
521 patients met inclusion criterion, mortality was 8.1%. CDI was present in 3.6% of the patients. 169 patients (32%) had nasal swabs performed for MRSA with 12.42% having positive swabs. We evaluated ISS, penetrating abdominal trauma index (PATI), CDI, MRSA positive nasal swabs for predictors of mortality. By logistic regression a MRSA positive nasal swab (p = 0.006) and ISS (p = 0.006) were the only two variables associated with increasing mortality risk. CDI was not significantly associated with mortality. There was no significant relationship between ISS, PATI, MRSA positive nasal swabs, SICU length of stay (LOS), ventilator days, or LOS and development of CDI. CDI positive patients had a longer mean LOS of 29.42 versus 14.07 days (p < 0.001). Patients with MRSA positive also had significantly longer mean LOS 21.4 versus 14.4 days (p = 0.042). There was no association between patients with MRSA positive nasal swabs and CDI. There was no finding of a higher likelihood of patients with MRSA positive nasal swabs developing CDI. Patients with MRSA positive nasal swabs had a six time increased risk of death. By Fisher's exact test the MRSA positive patients were more likely to die (p = 0.004).
CDI and MRSA positive patients had longer LOS. CDI was not associated with increased mortality. Only ISS and MRSA positive status predicted mortality. Sicker trauma patients were not more likely to develop CDI.
Routine infection control screening for MRSA may have other acuity implications.
Dionne Blyden, No Financial Disclosure Information; No Product/Research Disclosure Information