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

Published online by Cambridge University Press:  21 November 2017

Charlesnika T. Evans*
Affiliation:
Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois Department of Preventive Medicine and Center for Health Care Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
Margaret A. Fitzpatrick
Affiliation:
Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois Department of Internal Medicine, Stritch School of Medicine, Loyola University Chicago, Illinois
Makoto M. Jones
Affiliation:
Department of Veterans Affairs, VA Salt Lake City Healthcare System, Salt Lake City, Utah Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, Utah
Stephen P. Burns
Affiliation:
Spinal Cord Injury Service, Department of Veterans Affairs, VA Puget Sound Health Care System, Seattle, Washington Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
Linda Poggensee
Affiliation:
Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois
Swetha Ramanathan
Affiliation:
Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois
Sherri L. LaVela
Affiliation:
Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
Nasia Safdar
Affiliation:
Department of Veterans Affairs, William S. Middleton Memorial VA Hospital, Madison, Wisconsin Division of Infectious Diseases, Department of Medicine, University of Wisconsin, Madison, Wisconsin
Katie J. Suda
Affiliation:
Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois Department of Pharmacy, Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois-Chicago, Chicago, Illinois
*
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 (Charlesnika.evans@va.gov).

Abstract

OBJECTIVE

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).

DESIGN

Retrospective cohort study.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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

Type
Original Articles
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

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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