Bacterial infections may develop in about 5% of hospitalized patients with firearm injuries, with most occurring during the initial hospitalization and among patients undergoing head, neck, spine, or lower abdominal surgery, although infection was not independently associated with mortality among patients who survived at least 1 day of hospitalization.
Investigators used the Premier Healthcare Database to identify 24,024 adults hospitalized with firearm injuries between January 2019 and May 2021 at 323 hospitals that contributed microbiological data. Bacterial infections were classified as early when identified during the index hospitalization and late when first detected within 90 days postdischarge. Multivariable logistic regression adjusted for demographics, comorbidities, firearm characteristics, injury severity, and surgical procedures.
A secondary analysis examined whether bacterial infection during the index hospitalization was independently associated with mortality among patients who survived at least 1 day of hospitalization.
Overall, 5% (n = 1,236) of the patients developed bacterial infections. Early infections occurred in 4% (n = 1,034) of the patients, whereas 1% (n = 306) of them developed a new infection during the 90-day follow-up. Patients with bacterial infections received a median of 9 days of antimicrobial therapy. The most commonly isolated organisms were Escherichia coli (21%), Staphylococcus aureus (12%), and enterococci (12%). Mortality occurred in about 8% of the patients with bacterial infections and 8% of those without infections.
Among the patients who survived at least 1 day of hospitalization, surgery involving the head, neck, or spine was associated with more than five times the odds of early bacterial infection. Lower abdominal surgery was associated with nearly twice the odds of early infection, while liver surgery was associated with nearly four times the odds of late infection. Thoracic surgery and other abdominal procedures were associated with increased odds of early infection. By contrast, extremity surgery and handgun injuries were associated with lower odds of early bacterial infection.
Although the infection risk varied according to injury and surgical characteristics, bacterial infections during the initial hospitalization were not independently associated with mortality among those surviving 1 day of hospitalization.
The investigators noted that the study relied on administrative data and diagnosis codes, used a culture-based definition that may not have captured all clinically treated infections, and used surgical procedures and the New Injury Severity Score as proxies for injury severity. Complete 90-day follow-up may not have been available for all patients.
"Bacterial infection during initial hospitalization for firearm injury is common, but development of new infection during follow-up is rare. Among patients who survive at least 1 night in the hospital, bacterial infection was not independently associated with mortality," wrote lead study author Jerry Yang, BS, of the University of Maryland Institute for Health Computing and Harvard Medical School, and colleagues.
The study authors reported no conflicts of interest.
Source: JAMA Network Open
