AUTHOR=Schindler Cora Rebecca , Woschek Mathias , Franz Jan-Niklas , Störmann Philipp , Henrich Dirk , Marzi Ingo 

TITLE=Influence of Antibiotic Management on Microbial Selection and Infectious Complications After Trauma

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.678382

DOI=10.3389/fmed.2021.678382

ISSN=2296-858X

ABSTRACT=<p><bold>Background:</bold> The inflammatory response and post-traumatic complications like infections play an important role in the pathophysiology of severe injuries. This study examines the microbiological aspects in anti-infective treatment of trauma patients and their inflammatory response in post-traumatic infections complications.</p><p><bold>Patients and Methods:</bold> A retrospective analysis of prospectively collected data in trauma patients (ISS ≥ 16) over a 1-year period (01/2018 to 12/2018) is provided. Patient population was stratified into severely injured patients without post-traumatic infection (inf-PT), and severely injured patients who developed an infection (inf+PT).</p><p><bold>Results:</bold> Of 114 trauma patients, 45 suffered from post-traumatic infection during the first 10 days of hospitalization. Severely injured patients with concomitant traumatic brain injury (PT+TBI) showed the highest rate of post-traumatic infection. Pro-inflammatory reaction was tracked by levels of Interleukin (IL-)6 (day 3: inf+T 190.8 ± 359.4 pg/dL &gt; inf-PT 56.2 ± 57.7 pg/mL (mean ± SD); <italic>p</italic> = 0.008) and C-Reactive-Protein (CRP, day 3: inf+PT 15.3 mg/dL &gt; inf-PT 6.7 mg/dL, <italic>p</italic> = 0.001) which were significantly higher in trauma patients who develop an infectious complication and showed a significant positive correlation with the occurrence of infection. The leading entity of infection was pneumonia followed by infections of the urinary tract mainly caused by gram-negative <italic>Enterobacteriaceae</italic>. 67.5% of all trauma patients received single-shot antibiosis during initial care in trauma bay. The development of secondary colonization was not relevant positively correlated with single-shot antibiosis (<italic>r</italic> = 0.013, <italic>p</italic> = 0.895) and prophylactically calculated antibiotic administration (<italic>r</italic> = 0.066, <italic>p</italic> = 0.500).</p><p><bold>Conclusion:</bold> Severely injured trauma patients have an increased risk for development of infectious complications, which mainly is pneumonia followed by infection of the urinary tract mainly caused by gram-negative <italic>Enterobacteriaceae</italic>. Based on the data in this study, the one-time antibiotic and prophylactic calculated use of antibiotics, like Cephalosporins must be critically discussed in terms of their role in the development of post-traumatic infections and microbial selection.</p>