Epidemiology, risk factors, and antimicrobial resistance of nosocomial infections in the intensive care unit trauma patients: A cross-sectional study.

Abstract

Background: Healthcare-associated infections (HAIs) remain a critical challenge, particularly in trauma patients admitted to intensive care units (ICUs), who are at increased risk due to invasive procedures and prolonged hospitalization. This study aimed to investigate the prevalence, types, causative pathogens, and antibiotic resistance patterns of nosocomial infections in trauma patients.

Materials and methods: In this retrospective cross-sectional study conducted from March 2019 to March 2020, 45 trauma patients who developed nosocomial infections 48 h after ICU admission were analyzed. Data were collected from the hospital records and the Iranian Nosocomial Infection Surveillance System.

Results: Of 557 trauma patients admitted to the ICU, 45 (7.9%) developed 65 episodes of HAIs during the study, of which 12.3% (8/65) were polymicrobial. Ventilator-associated events (VAE) were the most common infection type (58.2%), followed by bloodstream (20.9%), surgical site (14.9%), and urinary tract infections (6%). Acinetobacter spp. was the most frequently isolated pathogen (49.4%), followed by Klebsiella spp. (27.7%). High levels of antibiotic resistance have been observed, particularly in Gram-negative bacteria. No statistically significant associations were found between infection type, trauma severity, or underlying comorbidities.

Conclusion: VAE and multidrug-resistant Acinetobacter species are major concerns in trauma patients in the ICU. Strengthening infection prevention protocols, especially ventilator care practices, and implementing antimicrobial stewardship programs are essential for mitigating infection risk. Furthermore, enhanced surveillance systems, targeted antibiotic therapy guided by local antibiograms, and multicenter research collaborations are strongly recommended for addressing the emerging threat of antibiotic-resistant nosocomial infections.