<i>Clostridium difficile</i>Infection in Critically Injured Trauma Patients

Lumpkins, Kimberly; Bochicchio, Grant V.; Joshi, Manjari; Gens, Ryan; Bochicchio, Kelly; Conway, Anne; Schaub, S; Scalea, Thomas M.

doi:10.1089/sur.2007.071

Cited by 22 publications

(33 citation statements)

References 17 publications

(21 reference statements)

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“…Additionally, a new, more virulent strain has been identified [5] correlating with the U.S. Centers for Disease Control and Prevention statement describing reports characterizing a new population of patients afflicted by CDI that had been believed previously to be at low risk [14]. This population includes a younger age group, with little-to-no antibiotic exposure or previous hospitalization [5,12,14]. These changes may be related in some way to the new strain of C. difficile, however, no evidence has shown an association between the new strain and this evolving clinical picture [15].…”

Section: Discussionmentioning

confidence: 99%

“…Although C. difficile after trauma has been reviewed previously [12,16], this is the largest current review of prospectively obtained data on CDI after severe blunt trauma. The mean age for our C. difficile population is representative of the standard age for trauma patients, but is significantly younger than that commonly accepted for CDI patients [5,12,16,17].…”

Section: Discussionmentioning

confidence: 99%

“…Incidence of CDI in the trauma population has been reported to be similar to that observed in the hospitalized population [12], which is surprising because demographics of trauma populations do not match the standard risk profile for CDI (age, hospital exposure, and antibiotics). Lumpkins et al [12] reported a significantly younger population of patients diagnosed with C. difficile, which was also associated with increased hospital and intensive care unit (ICU) lengths of stay (LOS). In addition, they reported CDI in trauma patients without antibiotic exposure, supporting the hypothesis that C. difficile after trauma may be associated with a different patient phenotype.…”

mentioning

confidence: 93%

“…To date, there have been few studies looking at C. difficile in the trauma population and those that have, report only a small sample size. The largest studies to date are by Lumpkins et al and Efron et al who reported sample sizes of 19 and 21, respectively [9,11,12]. Incidence of CDI in the trauma population has been reported to be similar to that observed in the hospitalized population [12], which is surprising because demographics of trauma populations do not match the standard risk profile for CDI (age, hospital exposure, and antibiotics).…”

mentioning

confidence: 99%

“…The largest studies to date are by Lumpkins et al and Efron et al who reported sample sizes of 19 and 21, respectively [9,11,12]. Incidence of CDI in the trauma population has been reported to be similar to that observed in the hospitalized population [12], which is surprising because demographics of trauma populations do not match the standard risk profile for CDI (age, hospital exposure, and antibiotics). Lumpkins et al [12] reported a significantly younger population of patients diagnosed with C. difficile, which was also associated with increased hospital and intensive care unit (ICU) lengths of stay (LOS).…”

mentioning

confidence: 99%

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Clostridium difficile Infections after Blunt Trauma: A Different Patient Population?

Vanzant

Ozrazgat‐Baslanti

Liu

et al. 2015

Surgical Infections

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Background: The epidemiology of Clostridium difficile-associated infection (CDI) has changed, and it is evident that susceptibility is related not only to exposures and bacterial potency, but host factors as well. Several small studies have suggested that CDI after trauma is associated with a different patient phenotype. The purpose of this study was to examine and describe the epidemiologic factors associated with C. difficile in blunt trauma patients without traumatic brain injury using the Trauma-Related Database as a part of the ''Inflammation and Host Response to Injury'' (Glue Grant) and the University of Florida Integrated Data Repository. Methods: Previously recorded baseline characteristics, clinical data, and outcomes were compared between groups (67 C. difficile and 384 uncomplicated, 813 intermediate, and 761 complicated non-C. difficile patients) as defined by the Glue Grant on admission and at days seven and 14. Results: The majority of CDI patients experienced complicated or intermediate clinical courses. The mean ages of all cohorts were less than 65 y and CDI patients were significantly older than uncomplicated patients without CDI. The CDI patients had increased days in the hospital and on the ventilator, as well as significantly higher new injury severity scores (NISS), and a greater percentage of patients with NISS > 34 points compared with non-CDI patients. They also had greater Marshall and Denver multiple organ dysfunction scores than non-CDI uncomplicated patients, and greater creatinine, alkaline phosphatase, neutrophil count, lactic acid, and P i O 2 : F i O 2 compared with all non-CDI cohorts on admission. In addition, the CDI patients had higher glucose concentrations and base deficit from uncomplicated patients and greater leukocytosis than complicated patients on admission. Several of these changes persisted to days seven and 14. Conclusion: Analysis of severe blunt trauma patients with C. difficile, as compared with non-CDI patients, reveals evidence of increased inflammation, immunosuppression, worse acute kidney injury, higher NISS, greater days in the hospital and on the ventilator, higher organ injury scores, and prolonged clinical courses. This supports reports of an increased prevalence of CDI in a younger population not believed previously to be at risk. This unique population may have specific genomic or inflammation-related risk factors that may play more important roles in disease susceptibility. Prospective analysis may allow early identification of at-risk patients, creation of novel therapeutics, and improved understanding of how and why C. difficile colonization transforms into infection after severe blunt trauma.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 93%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Clostridium difficile Infections after Blunt Trauma: A Different Patient Population?

Vanzant

Ozrazgat‐Baslanti

Liu

et al. 2015

Surgical Infections

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Trauma-toxicology: concepts, causes, complications

Barth,

Worek,

Steinritz

et al. 2023

Naunyn-Schmiedeberg's Arch Pharmacol

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Trauma and toxic substances are connected in several aspects. On the one hand, toxic substances can be the reason for traumatic injuries in the context of accidental or violent and criminal circumstances. Examples for the first scenario is the release of toxic gases, chemicals, and particles during house fires, and for the second scenario, the use of chemical or biological weapons in the context of terroristic activities. Toxic substances can cause or enhance severe, life-threatening trauma, as described in this review for various chemical warfare, by inducing a tissue trauma accompanied by break down of important barriers in the body, such as the blood-air or the blood-gut barriers. This in turn initiates a “vicious circle” as the contribution of inflammatory responses to the traumatic damage enhances the macro- and micro-barrier breakdown and often results in fatal outcome. The development of sophisticated methods for detection and identification of toxic substances as well as the special treatment of the intoxicated trauma patient is summarized in this review. Moreover, some highly toxic substances, such as the protein toxins from the pathogenic bacterium Clostridioides (C.) difficile, cause severe post-traumatic complications which significantly worsens the outcome of hospitalized patients, in particular in multiply injured trauma patients. Therefore, novel pharmacological options for the treatment of such patients are necessarily needed and one promising strategy might be the neutralization of the toxins that cause the disease. This review summarizes recent findings on the molecular and cellular mechanisms of toxic chemicals and bacterial toxins that contribute to barrier breakdown in the human body as wells pharmacological options for treatment, in particular in the context of intoxicated trauma patients. “trauma-toxicology” comprises concepts regrading basic research, development of novel pharmacological/therapeutic options and clinical aspects in the complex interplay and “vicious circle” of severe tissue trauma, barrier breakdown, pathogen and toxin exposure, tissue damage, and subsequent clinical complications.

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Clostridium difficile-Associated Disease Acquired in the Neurocritical Care Unit

et al. 2010

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Clostridium difficileInfection in Critically Injured Trauma Patients

Abstract: Clostridium difficile infection occurred in 3.3% of patients and was diagnosed as early as the fourth hospital day. We have identified a unique subgroup of younger patients who developed CDI after minimal or no antibiotic exposure. Further study is needed to characterize this population.

Cited by 22 publications

References 17 publications

Clostridium difficile Infections after Blunt Trauma: A Different Patient Population?

Clostridium difficile Infections after Blunt Trauma: A Different Patient Population?

Trauma-toxicology: concepts, causes, complications

Clostridium difficile-Associated Disease Acquired in the Neurocritical Care Unit

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