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

Lee, Sung Ji; Kang, Seung Ji; Jang, Mi Ok; Jung, Sook In; Park, Kyung Hwa

Abstract

BACKGROUND/AIMS: Tetanus is a fatal disease and various complications affect its prognosis. In Korea, tetanus cases have been reported, but no studies, thus far, have examined its complications. We investigated the complications of tetanus and analyzed the risk factors for nosocomial pneumonia, one of most common complications of tetanus.
METHODS
We retrospectively reviewed the clinical features, treatment, and complications of 42 patients diagnosed with tetanus at Chonnam National University Hospital from January 1999 through June 2008. The severity of tetanus was assessed using the APACHE II and Ablett scores. We compared two groups, one with nosocomial pneumonia and the other without it, and analyzed the risk factors for nosocomial pneumonia.
RESULTS
Forty-two patients (13 men, 29 women) were enrolled. Only three of them had received a primary tetanus vaccination; the others had not received primary or booster vaccinations. Twenty-one patients needed mechanical ventilation. The most common infectious complication was pneumonia (47.4%), followed by blood stream (15.8%) and urinary tract (13.2%) infections. Regarding noninfectious complications, dysautonomia was also common, including fluctuating blood pressure (31.6%), arrhythmias (26.3%), and cardiac arrest (7.9%). Nosocomial pneumonia was associated with autonomic disturbance (OR=32.0, 95% CI 1.9-524.2; p=0.005) and length of stay in the intensive care unit (OR=1.145, 95% CI 1.02-1.29; p=0.024) in the multivariate analysis.
CONCLUSIONS
Careful monitoring and treatment of complications are essential in managing tetanus, along with specific therapy for tetanus itself. Education and tetanus immunization are important for preventing the disease, especially in high-risk areas.