Incidence of and risk factors for nosocomial pneumonia in patients with tetanus.

Abstract

From June 1998 through July 2000, 28 patients with tetanus admitted to the Intensive Care Unit for Tetanus and Infectious Diseases at the Hospital das Clínicas of University of Medicine at São Paulo, Brazil, were evaluated to establish what the incidence of nosocomial pneumonia was and what their risk factors were. The degree of severity of tetanus was assessed in all patients by means of APACHE II scores. The mortality rate was 3.6%. There were 63 hospital infections in 20 patients; among these, there were 10 cases of nosocomial pneumonia in 8 patients. Nosocomial pneumonia was associated in univariate analysis with the degree of severity of tetanus, dysautonomy, use of neuromuscular blockers, use of higher doses of diazepam, and lower arterial oxygen and oxygen fractions. In the multiple logistical regression, significance was found for dysautonomy (relative risk, 31.67; 95% confidence interval, 2.68-373.74; P=.006). Dysautonomy was an independent risk factor for pneumonia in patients with tetanus.