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Prevalence and Factors Associated With Multidrug-Resistant Gram-Negative Organisms in Patients With Spinal Cord Injury

  • Charlesnika T. Evans (a1) (a2), Margaret A. Fitzpatrick (a1) (a3), Makoto M. Jones (a4) (a5), Stephen P. Burns (a6) (a7), Linda Poggensee (a1), Swetha Ramanathan (a1), Sherri L. LaVela (a1) (a8), Nasia Safdar (a9) (a10) and Katie J. Suda (a1) (a11)...



Infections caused by multidrug-resistant gram-negative organisms (MDRGNOs) have been increasing every year. The objective of this study was to describe the prevalence of MDRGNOs and factors associated with MDRGNOs in patients with spinal cord injury or disorder (SCI/D).


Retrospective cohort study.


Department of Veterans Affairs (VA) electronic health record data from 142 VA facilities were evaluated for 19,642 patients with SCI/D. Multivariable cluster-adjusted models were fit to identify factors associated with MDRGNO.


Gram-negative (GN) cultures occurred in 44% of patients with SCI/D receiving care at VA facilities, and 11,527 (41.3%) GN cultures had an MDRGNO. The most frequent GN organisms (GNOs) were Escherichia coli (28.5%), Klebsiella pneumoniae (17.0%), and Pseudomonas aeruginosa (16.0%). Two-thirds of GN cultures were from the outpatient setting, where MDRGNO prevalence was 37.6%. Significant geographic variation in the prevalence of MDRGNOs was identified (South, 44.7%; Northeast, 44.3%; West, 36.8%; Midwest, 34.4%). Other factors associated with an MDRGNO were older age, injury characteristics, comorbidities, specimen type, healthcare setting, and healthcare exposure. Black (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.39–1.78) and Hispanic race (OR, 1.58; 95% CI, 1.28–1.95), polymicrobial culture (OR, 2.67; 95% CI, 2.46–2.90), and antibiotic use in the previous 90 days (OR, 1.62; 95% CI, 1.50–1.76) were also associated with having an MDRGNO.


MDRGNOs were common in community and healthcare settings among veterans with SCI/D, with significant geographic variation. Health care and antibiotic exposures were significant factors associated with MDRGNOs. Priority should be given to controlling the spread of MDRGNOs in this special population, including a focus on judicious use of antibiotics.

Infect Control Hosp Epidemiol 2017;38:1464–1471


Corresponding author

Address correspondence to Charlesnika T. Evans, PhD, MPH, Edward Hines Jr. VA Hospital, 5000 S. 5th Avenue (151H), Building 1, Room D302, Hines, Il 60141 (


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PREVIOUS PRESENTATION. This work was presented in part at the Annual Paralyzed Veterans of America Summit 2016, on August 30, 2016, in Orlando, Florida, and at IDWeek 2016 on October 27, 2016, New Orleans, LA (Poster 318).



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Prevalence and Factors Associated With Multidrug-Resistant Gram-Negative Organisms in Patients With Spinal Cord Injury

  • Charlesnika T. Evans (a1) (a2), Margaret A. Fitzpatrick (a1) (a3), Makoto M. Jones (a4) (a5), Stephen P. Burns (a6) (a7), Linda Poggensee (a1), Swetha Ramanathan (a1), Sherri L. LaVela (a1) (a8), Nasia Safdar (a9) (a10) and Katie J. Suda (a1) (a11)...


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