{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T10:36:03Z","timestamp":1786703763890,"version":"build-2736575974"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100008331","name":"Universidade Federal Do Rio De Janeiro","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100008331","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infection"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize the clinical profile, intensive care course, Ablett severity, healthcare-associated infections (HAIs), microbiology, and outcomes of patients with accidental tetanus treated at a Brazilian referral hospital over a 13-year period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study at the Instituto Estadual de Infectologia S\u00e3o Sebasti\u00e3o\/Hospital Federal dos Servidores do Estado (Rio de Janeiro, Brazil). Consecutive patients aged\u2009&gt;\u200928 days with accidental tetanus admitted between 2013 and 2025 were included according to national surveillance criteria. Categorical variables were summarized as counts and percentages, and continuous variables as means and standard deviations or medians and interquartile ranges (IQR), as appropriate. Associations with in-hospital mortality were explored in univariate analyses using the Fisher exact test and crude odds ratios (OR) with 95% confidence intervals (95% CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty patients were included; most were male and urban residents, with a median age of 43 years (IQR 29.0\u201360.8). ICU admission occurred in 28\/30 (93.3%); 25\/30 (83.3%) required mechanical ventilation and 24\/30 (80%) underwent tracheostomy. ICU length of stay was prolonged (median 28.0 days, IQR 13.0\u201344.8). HAIs occurred in 21\/30 (70%), predominantly ventilator-associated pneumonia (20\/30; 66.7%); the most frequent pathogens were\n                      <jats:italic>Acinetobacter baumannii<\/jats:italic>\n                      ,\n                      <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                      , and\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      . In-hospital mortality was 8\/30 (26.7%), concentrated among patients aged\u2009\u2265\u200960 years (OR 6.25, 95% CI 1.02\u201338.08) and among those with Ablett grade IV disease (8\/18; 44.4%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Severe accidental tetanus was associated with prolonged ICU stay, high ventilatory support requirements, and a substantial VAP-related infection burden, supporting catch-up vaccination strategies and rigorous airway management, ventilator-weaning, VAP-prevention, and antimicrobial-stewardship practices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s15010-026-02826-7","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T09:21:34Z","timestamp":1779096094000},"page":"1981-1990","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and epidemiological profile of patients with accidental tetanus in a referral hospital: a 13-year historical series"],"prefix":"10.1007","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8373-2958","authenticated-orcid":false,"given":"Elaine Cristina","family":"de Oliveira Souza","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8478-9753","authenticated-orcid":false,"given":"Julia Guedes Valentim","family":"do Nascimento","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5339-6323","authenticated-orcid":false,"given":"Victor","family":"Ota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9965-7330","authenticated-orcid":false,"given":"Arthur Duarte Fantesia Costa","family":"Cruz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2732-415X","authenticated-orcid":false,"given":"Caroline Alves","family":"da Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3562-5927","authenticated-orcid":false,"given":"Ana Luiza Martins","family":"de Oliveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0273-6911","authenticated-orcid":false,"given":"Claudia Caminha","family":"Escosteguy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0348-8374","authenticated-orcid":false,"given":"Rafael Mello","family":"Galliez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"2826_CR1","doi-asserted-by":"crossref","unstructured":"Farrar JJ, Yen LM, Cook T, et al. Tetanus. J Neurol Neurosurg Psychiatry. 2000;69(3):292\u2013301.","DOI":"10.1136\/jnnp.69.3.292"},{"issue":"6","key":"2826_CR2","first-page":"53","volume":"92","author":"World Health Organization","year":"2017","unstructured":"World Health Organization. Tetanus vaccines: WHO position paper \u2013 February 2017. Wkly Epidemiol Rec. 2017;92(6):53\u201376.","journal-title":"Wkly Epidemiol Rec"},{"key":"2826_CR3","volume-title":"Tetanus","author":"World Health Organization","year":"2024","unstructured":"World Health Organization. Tetanus. Geneva: World Health Organization; 2024."},{"key":"2826_CR4","volume-title":"Boletim Epidemiol\u00f3gico (v. 53, n. 42): Situa\u00e7\u00e3o epidemiol\u00f3gica do t\u00e9tano acidental no Brasil, 2018\u20132021 e SE 1\u201332 de 2022","author":"Ministry of Health (Brazil)","year":"2022","unstructured":"Ministry of Health (Brazil). Boletim Epidemiol\u00f3gico (v. 53, n. 42): Situa\u00e7\u00e3o epidemiol\u00f3gica do t\u00e9tano acidental no Brasil, 2018\u20132021 e SE 1\u201332 de 2022. Bras\u00edlia: Minist\u00e9rio da Sa\u00fade; 2022."},{"issue":"1","key":"2826_CR5","doi-asserted-by":"publisher","first-page":"22","DOI":"10.7774\/cevr.2017.6.1.22","volume":"6","author":"HJ Lee","year":"2017","unstructured":"Lee HJ, Choi JH. Tetanus-diphtheria-acellular pertussis vaccination for adults: an update. Clin Exp Vacc Res. 2017;6(1):22\u201330.","journal-title":"Clin Exp Vacc Res"},{"issue":"1","key":"2826_CR6","first-page":"7","volume":"61","author":"S Anuradha","year":"2006","unstructured":"Anuradha S. Tetanus in adults\u2013a continuing problem: an analysis of 217 patients over 3 years from Delhi, India, with special emphasis on predictors of mortality. Med J Malays. 2006;61(1):7\u201314.","journal-title":"Med J Malays"},{"issue":"3","key":"2826_CR7","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1177\/0049475514526714","volume":"44","author":"HE Harding","year":"2014","unstructured":"Harding HE, Cawich SO, Williams EW, Crandon IW, Williams-Johnson J. Epidemiology of tetanus in Jamaica, 1993\u20132010. Trop Doct. 2014;44(3):166\u20138.","journal-title":"Trop Doct"},{"issue":"1\u20132","key":"2826_CR8","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/j.jns.2012.02.028","volume":"317","author":"A Amare","year":"2012","unstructured":"Amare A, Melkamu Y, Mekonnen D. Tetanus in adults: clinical presentation, treatment and predictors of mortality in a tertiary hospital in Ethiopia. J Neurol Sci. 2012;317(1\u20132):62\u20135.","journal-title":"J Neurol Sci"},{"issue":"10","key":"2826_CR9","doi-asserted-by":"publisher","first-page":"1329","DOI":"10.1590\/S0100-879X2006001000009","volume":"39","author":"DB Miranda-Filho","year":"2006","unstructured":"Miranda-Filho DB, Ximenes RAA, Barone AA, Vaz VL, Vieira AG, Albuquerque VMG. Clinical classification of tetanus patients. Braz J Med Biol Res. 2006;39(10):1329\u201337.","journal-title":"Braz J Med Biol Res"},{"issue":"3","key":"2826_CR10","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1111\/j.1365-3156.2006.01562.x","volume":"11","author":"CL Thwaites","year":"2006","unstructured":"Thwaites CL, Yen LM, Loan HT, et al. Predicting the clinical outcome of tetanus: The Tetanus Severity Score. Trop Med Int Health. 2006;11(3):279\u201387.","journal-title":"Trop Med Int Health"},{"issue":"1","key":"2826_CR11","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1186\/s13613-017-0333-y","volume":"7","author":"R Mahieu","year":"2017","unstructured":"Mahieu R, Reydel T, Maamar A, et al. Admission of tetanus patients to the ICU: a retrospective multicentre study. Ann Intensive Care. 2017;7(1):112.","journal-title":"Ann Intensive Care"},{"key":"2826_CR12","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1016\/j.jcrc.2017.12.025","volume":"44","author":"M Nakajima","year":"2018","unstructured":"Nakajima M, Aso S, Matsui H, Fushimi K, Yasunaga H. Clinical features and outcomes of tetanus: analysis using a national inpatient database in Japan. J Crit Care. 2018;44:388\u201391.","journal-title":"J Crit Care"},{"issue":"21\u201322","key":"2826_CR13","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1007\/s00508-023-02222-3","volume":"135","author":"NG Kmet","year":"2023","unstructured":"Kmet NG, Muzlovi\u010d I, Martin\u010di\u010d \u017d, \u0160tubljar D, Jereb M. Adult patients with tetanus in Slovenia 2006\u20132021: results of a national cohort study. Wien Klin Wochenschr. 2023;135(21\u201322):625\u201330.","journal-title":"Wien Klin Wochenschr"},{"issue":"7","key":"2826_CR14","doi-asserted-by":"publisher","first-page":"1654","DOI":"10.3390\/microorganisms13071654","volume":"13","author":"AM P\u0103una","year":"2025","unstructured":"P\u0103una AM, Gheorghi\u021b\u0103 C, Ceau\u0219u E, et al. Tetanus in Romania\u2014trends and challenges (2010\u20132023). Microorganisms. 2025;13(7):1654.","journal-title":"Microorganisms"},{"key":"2826_CR15","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1016\/j.jns.2016.07.025","volume":"368","author":"YW Woldeamanuel","year":"2016","unstructured":"Woldeamanuel YW, Andemeskel AT, Kyei K, Woldeamanuel MW, Woldeamanuel W. Case fatality of adult tetanus in Africa: systematic review and meta-analysis. J Neurol Sci. 2016;368:292\u20139.","journal-title":"J Neurol Sci"},{"key":"2826_CR16","unstructured":"Ministry of Health (Brazil). Notifica\u00e7\u00e3o compuls\u00f3ria [Internet]. Bras\u00edlia: Minist\u00e9rio da Sa\u00fade; 2024 [cited 2024 Oct 22]. https:\/\/www.gov.br\/saude\/pt-br\/composicao\/svsa\/notificacao-compulsoria"},{"key":"2826_CR17","unstructured":"R Core Team. (2024). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria. https:\/\/www.R-project.org\/"},{"issue":"5","key":"2826_CR18","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1016\/j.bjid.2016.06.007","volume":"20","author":"MV N\u00f3brega","year":"2016","unstructured":"N\u00f3brega MV, Reis RC, Aguiar IC, et al. Patients with severe accidental tetanus admitted to an intensive care unit in Northeastern Brazil: clinical-epidemiological profile and risk factors for mortality. Braz J Infect Dis. 2016;20(5):457\u201361.","journal-title":"Braz J Infect Dis"},{"key":"2826_CR19","doi-asserted-by":"crossref","unstructured":"Carvalho LC, Marques CPC, Rodrigues VP. Temporal trends in tetanus incidence and lethality in Brazil: analysis of the national database from 2009 to 2018. Rev Assoc Med Bras (1992). 2021;67(12):1804\u20131809.","DOI":"10.1590\/1806-9282.20210736"},{"issue":"1","key":"2826_CR20","doi-asserted-by":"publisher","first-page":"1811","DOI":"10.36557\/2674-8169.2024v6n1p1811-1826","volume":"6","author":"RL Curzio","year":"2024","unstructured":"Curzio RL, Dieguez AC, AndradeAH, Amarante BT, Ruela GA. Epidemiological profile of accidental tetanus in the Northeast region of Brazil between 2007 and 2022. Braz J Implantol Health Sci. 2024;6(1):1811\u201326.","journal-title":"Braz J Implantol Health Sci"},{"issue":"1","key":"2826_CR21","first-page":"1","volume":"9","author":"MVT Martins","year":"2021","unstructured":"Martins MVT, Mendes GJ, Soares LC, da Silva ARL, Oliveira SV de. An\u00e1lise epidemiol\u00f3gica e avalia\u00e7\u00e3o dos gastos\/efetividade nas interna\u00e7\u00f5es por t\u00e9tano no Brasil. J Health Biol Sci. 2021;9(1):1\u20138.","journal-title":"J Health Biol Sci"},{"key":"2826_CR22","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.ijid.2023.11.023","volume":"139","author":"Y Li","year":"2023","unstructured":"Li Y, Roberts JA, Walker MM, et al. The global epidemiology of ventilator-associated pneumonia caused by multi-drug resistant Pseudomonas aeruginosa: a systematic review and meta-analysis. Int J Infect Dis. 2023;139:78\u201385.","journal-title":"Int J Infect Dis"},{"key":"2826_CR23","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1016\/j.jinf.2019.09.012","volume":"79","author":"SMS Lim","year":"2019","unstructured":"Lim SMS, Zainal Abidin A, Sime F, et al. The global prevalence of multidrug-resistance among Acinetobacter baumannii causing hospital-acquired and ventilator-associated pneumonia and its associated mortality: a systematic review and meta-analysis. J Infect. 2019;79:593\u2013600.","journal-title":"J Infect"},{"key":"2826_CR24","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/s41182-021-00336-w","volume":"49","author":"R Davies-Foote","year":"2021","unstructured":"Davies-Foote R, Trung TN, Duoc NVT, et al. Risk factors associated with mechanical ventilation, autonomic nervous dysfunction and physical outcome in Vietnamese adults with tetanus. Trop Med Health. 2021;49:50.","journal-title":"Trop Med Health"},{"key":"2826_CR25","doi-asserted-by":"publisher","first-page":"1855","DOI":"10.2147\/IJGM.S512024","volume":"18","author":"J Xu","year":"2025","unstructured":"Xu J, Wang Y, Huang G, Zhou L, Mo X, Yang N, et al. Factors influencing the length of emergency intensive care unit stay in adult tetanus patients. Int J Gen Med. 2025;18:1855\u201364.","journal-title":"Int J Gen Med"},{"issue":"Suppl 2","key":"2826_CR26","first-page":"S155","volume":"25","author":"DR Karnad","year":"2021","unstructured":"Karnad DR, Gupta V. Intensive care management of severe tetanus. Indian J Crit Care Med. 2021;25(Suppl 2):S155\u201360.","journal-title":"Indian J Crit Care Med"},{"issue":"3","key":"2826_CR27","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1590\/S0102-311X2007000300015","volume":"23","author":"R Gomes","year":"2007","unstructured":"Gomes R, do Nascimento EF, de Ara\u00fajo FC. Por que os homens buscam menos os servi\u00e7os de sa\u00fade do que as mulheres? As explica\u00e7\u00f5es de homens com baixa escolaridade e homens com ensino superior. Cad Sa\u00fade P\u00fablica. 2007;23(3):565\u201374.","journal-title":"Cad Sa\u00fade P\u00fablica"},{"issue":"2","key":"2826_CR28","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1590\/S0104-12902013000200013","volume":"22","author":"MA Separavich","year":"2013","unstructured":"Separavich MA, Canesqui AM. Sa\u00fade do homem e masculinidades na Pol\u00edtica Nacional de Aten\u00e7\u00e3o Integral \u00e0 Sa\u00fade do Homem: uma revis\u00e3o bibliogr\u00e1fica. Saude soc. 2013;22(2):415\u201328.","journal-title":"Saude soc"},{"key":"2826_CR29","first-page":"e250258","volume":"29","author":"CC Brand\u00e3o","year":"2025","unstructured":"Brand\u00e3o CC, Salerno AAP, Medrado B, Barros EA, dos S, de Albuquerque FP, Fernandes Filho HP, et al. Pol\u00edtica Nacional de Aten\u00e7\u00e3o Integral \u00e0 Sa\u00fade do Homem: 15 anos de importantes avan\u00e7os e persistentes desafios. Interface (Botucatu). 2025;29:e250258.","journal-title":"Interface (Botucatu)"},{"key":"2826_CR30","unstructured":"Conselho Nacional de Sa\u00fade (Brasil). Resolu\u00e7\u00e3o n. 466, de 12 de dezembro de 2012. Bras\u00edlia, 2012. Available from: https:\/\/bvsms.saude.gov.br\/bvs\/saudelegis\/cns\/2013\/res0466_12_12_2012.html"}],"container-title":["Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-026-02826-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s15010-026-02826-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-026-02826-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T10:09:58Z","timestamp":1786702198000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s15010-026-02826-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,18]]},"references-count":30,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["2826"],"URL":"https:\/\/doi.org\/10.1007\/s15010-026-02826-7","relation":{},"ISSN":["0300-8126","1439-0973"],"issn-type":[{"value":"0300-8126","type":"print"},{"value":"1439-0973","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,18]]},"assertion":[{"value":"25 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The research ethics committee of the \u201cHospital Federal dos Servidores do Estado\u201d approved the study, under protocol number 6.027.619, CAAE (submission for ethical review) 48749021.3.00005252, in accordance with Directive 466\/2012 of the National Health Council [\n                      \n                      ]. Informed consent was not required, as only de-identified and secondary data from the institution\u2019s databases were used. Data were handled in de-identified form, and confidentiality was maintained throughout. Reporting follows STROBE guidelines, the completed checklist is provided in the appendix. The analysis code will be made publicly available, and de-identified data will be shared in accordance with the data-sharing statement.","order":3,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"During the preparation of this work, the authors used ChatGPT Plus, version 5.2-Thinking (OpenAI San Francisco, CA, USA) for language editing (grammar, clarity, and adherence to formal academic register) and for translation from Brazilian Portuguese into English. After using this tool\/service, the authors reviewed and edited the content as needed and take full responsibility for the final manuscript.","order":4,"name":"Ethics","label":"Declarations of generative AI and AI-assisted technologies in the manuscript preparation process","group":{"name":"EthicsHeading","label":"Declarations"}}]}}