Clinical and epidemiological profile of patients with accidental tetanus in a referral hospital: a 13-year historical series

Abstract Objective 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. Methods We conducted a retrospective cohort study at the Instituto Estadual de Infectologia São Sebastião/Hospital Federal dos Servidores do Estado (Rio de Janeiro, Brazil). Consecutive patients aged > 28 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). Results Thirty patients were included; most were male and urban residents, with a median age of 43 years (IQR 29.0–60.8). 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 13.0–44.8). HAIs occurred in 21/30 (70%), predominantly ventilator-associated pneumonia (20/30; 66.7%); the most frequent pathogens were Acinetobacter baumannii , Pseudomonas aeruginosa , and Staphylococcus aureus . In-hospital mortality was 8/30 (26.7%), concentrated among patients aged ≥ 60 years (OR 6.25, 95% CI 1.02–38.08) and among those with Ablett grade IV disease (8/18; 44.4%). Conclusion 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.