Nosocomial and Healthcare Associated Infections

Introduction: Severe multiple traumas are the main non-specific factor that causes early immune imbalance, which in turn

acutely increases the risks of development of infectious complications in the affected areas. In a comparative individual analysis

of deviations in the values of immunogram parameters, more than a third of victims with severe multiple trauma, an imbalance in

hypoergic or hyperergic type is observed already on the first day. Currently there are nearly no data justifying the conduction of early

immunosuppressive therapy at early stage of multiple trauma and to assess its impact on the development of nosocomial infection

and the parameters of immune system.

Aim of the Study: Evaluation of the effectiveness of early immunosubstitution therapy (IST) in patients with severe multiple trauma

(SMT).

Materials & Methods: 225 patients with severe co-occurring trauma (ISS>30 points) were examined. The mean age was 35.5±14.1

years. Depending on the use of early IST therapy with donor IgG (daily for the first three days) patients were split into two groups:

the first- 126 patients with standard intensive treatment supplemented with IST; the second-99 victims, who did not receive IST.

Immunological examination was performed on days 1, 3, 6 and 9 after trauma. The relative and absolute number of lymphocytes

of the main populations were determined: (CD3+)-T lymphocytes and (CD19+)-B lymphocytes; T cell subpopulations: (CD4+)

T helper and (CD8+) T cytotoxic lymphocytes, concentration of immunoglobulins class A, G, M (IgA, IgG, IgM); absorbing and

bactericidal activity of neutrophils; serum content of circulating immune complexes: large, medium and small, as well as concentration

of C-reactive protein (CRP) and procalcitonin (PCT). In both groups the severity of the condition was assessed according to the

APACE-II scale (in dynamics), duration of mechanical ventilation, incidence of nosocomial pneumonia, CPIS score (in dynamics)

and outcome.

Results: The study showed that in the group of victims who received IST the need for prolonged mechanical ventilation was 1.7 times less

infectious complications developed 1.4 times less, the signs of nosocomial pneumonia decreased on the CPIS scale and the mortality

decreased by 1.6 times. The favorable course of the posttraumatic period was expressed in the improvement of the APACE-II scale

and the reduction of the ICU stay for more than 7.5 days.

Conclusion: The use of early immunosuppressive therapy in the treatment of patients with severe multiple trauma reduced the

duration of mechanical ventilation and the incidence of nosocomial pneumonia, which in turn reduced mortality in the investigation

group.