{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T09:55:40Z","timestamp":1762509340387,"version":"3.44.0"},"reference-count":33,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T00:00:00Z","timestamp":1755734400000},"content-version":"unspecified","delay-in-days":51,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2025,7,22]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>A time sequence occurs in pathogens leading to infections in Intensive Care Unit (ICU) patients with a compromised immune system. A similar pattern may also occur in (multi)trauma patients characterized by similar impaired immunological responses. Such immune malfunction might be prolonged and enable hospital-acquired pathogens (selected through antibiotic regimens) to cause infections. This study investigated the timing of infections and associated pathogens in severely injured trauma patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A retrospective, single-center cohort study was conducted at a level-1 trauma center. Severely injured trauma patients from 2013 to 2022 with an ICU stay &gt;48 hours were included. Infections compliant with the criteria of the Centers for Disease Control and Prevention and causative pathogens were documented. Timing of infections was scored as days after trauma.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>109 out of 572 severely injured trauma patients developed infectious complications. All patients received antibiotics. A time sequence of pathogens that caused infections was observed. <jats:italic>Staphylococcus aureus<\/jats:italic>, <jats:italic>Enterococcus<\/jats:italic> spp., and CoNS were mainly responsible for infections before day 40 after trauma. From day 60 onward<jats:italic>, Klebsiella<\/jats:italic> spp., <jats:italic>Candida<\/jats:italic> spp.<jats:italic>, Enterobacter<\/jats:italic> spp.<jats:italic>, and Pseudomonas<\/jats:italic> spp. became more frequent.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>A time sequence in occurrence of pathogens and associated infections was found in severely injured trauma patients. Commensal micro-organisms were predominant in the first weeks after trauma, which shifted toward hospital-acquired microorganisms over time. This observed time sequence is consistent with the hypothesis that a long-term imbalanced innate immune system facilitates infections with these normally non-pathogenic organisms during months after severe trauma. <\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>This was a retrospective cohort study with level III evidence.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2025-001859","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T10:30:25Z","timestamp":1755772225000},"page":"e001859","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Time sequence of bacterial and fungal pathogens causing infections in trauma patients"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3522-515X","authenticated-orcid":false,"given":"Frederique 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