Margaret A Fitzpatrick1,2, Katie J Suda1,3, Nasia Safdar4,5, Stephen P Burns6,7, Makoto M Jones8,9, Linda Poggensee1, Swetha Ramanathan1, Charlesnika T Evans1,10. 1. a Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines , Jr. VA Hospital , Hines , Illinois , USA. 2. b Department of Medicine, Division of Infectious Diseases , Loyola University Stritch School of Medicine , Maywood , Illinois , USA. 3. c Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy , University of Illinois at Chicago , Chicago , Illinois , USA. 4. d Department of Veterans Affairs, William S. Middleton VA Medical Center , Madison , Wisconsin , USA. 5. e Department of Medicine, Division of Infectious Diseases , University of Wisconsin , Madison , Wisconsin , USA. 6. f Department of Veterans Affairs, VA Puget Sound Healthcare System , Seattle , Washington , USA. 7. g Department of Rehabilitation Medicine , University of Washington , Seattle , Washington , USA. 8. h Department of Veterans Affairs , VA Salt Lake City Healthcare System , Salt Lake City , Utah , USA. 9. i Department of Medicine, Division of Epidemiology , University of Utah , Salt Lake City , Utah , USA. 10. j Center for Healthcare Studies and Department of Preventive Medicine Institute for Public Health and Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA.
Abstract
OBJECTIVE: Patients with spinal cord injury and disorder (SCI/D) have an increased risk of infection with multidrug-resistant (MDR) bacteria. We described bacterial epidemiology and resistance in patients with SCI/D at Veterans Affairs Medical Centers (VAMCs) for the past 9 years. DESIGN: Retrospective cohort. SETTING: One hundred thirty VAMCs. PARTICIPANTS: Veterans with SCI/D and bacterial cultures with antibiotic susceptibility testing performed between 1/1/2005-12/31/2013. Single cultures with contaminants and duplicate isolates within 30 days of initial isolates were excluded. INTERVENTIONS: None. OUTCOMES: Trends in microbial epidemiology and antibiotic resistance. RESULTS: Included were 216,504 isolates from 19,421 patients. Urine was the most common source and Gram-negative bacteria (GNB) were isolated most often, with 36.1% of GNB being MDR. Logistic regression models clustered by patient and adjusted for location at an SCI/D center and geographic region showed increased odds over time of vancomycin resistance in Enterococcus [adjusted odds ratio (aOR) 1.67, 95% confidence interval (CI) 1.30-2.15], while methicillin resistance in Staphylococcus aureus remained unchanged (aOR 0.90, 95% CI 0.74-1.09). There were also increased odds of fluoroquinolone resistance (aOR 1.39, 95% CI 1.31-1.47) and multidrug resistance (aOR 1.46, 95% CI 1.38-1.55) in GNB, with variability in the odds of MDR bacteria by geographic region. CONCLUSIONS: GNB are isolated frequently in Veterans with SCI/D and have demonstrated increasing resistance over the past 9 years. Priority should be given to controlling the spread of resistant bacteria in this population. Knowledge of local and regional epidemiologic trends in antibiotic resistance in patients with SCI/D may improve appropriate antibiotic prescribing.
OBJECTIVE:Patients with spinal cord injury and disorder (SCI/D) have an increased risk of infection with multidrug-resistant (MDR) bacteria. We described bacterial epidemiology and resistance in patients with SCI/D at Veterans Affairs Medical Centers (VAMCs) for the past 9 years. DESIGN: Retrospective cohort. SETTING: One hundred thirty VAMCs. PARTICIPANTS: Veterans with SCI/D and bacterial cultures with antibiotic susceptibility testing performed between 1/1/2005-12/31/2013. Single cultures with contaminants and duplicate isolates within 30 days of initial isolates were excluded. INTERVENTIONS: None. OUTCOMES: Trends in microbial epidemiology and antibiotic resistance. RESULTS: Included were 216,504 isolates from 19,421 patients. Urine was the most common source and Gram-negative bacteria (GNB) were isolated most often, with 36.1% of GNB being MDR. Logistic regression models clustered by patient and adjusted for location at an SCI/D center and geographic region showed increased odds over time of vancomycin resistance in Enterococcus [adjusted odds ratio (aOR) 1.67, 95% confidence interval (CI) 1.30-2.15], while methicillin resistance in Staphylococcus aureus remained unchanged (aOR 0.90, 95% CI 0.74-1.09). There were also increased odds of fluoroquinolone resistance (aOR 1.39, 95% CI 1.31-1.47) and multidrug resistance (aOR 1.46, 95% CI 1.38-1.55) in GNB, with variability in the odds of MDR bacteria by geographic region. CONCLUSIONS: GNB are isolated frequently in Veterans with SCI/D and have demonstrated increasing resistance over the past 9 years. Priority should be given to controlling the spread of resistant bacteria in this population. Knowledge of local and regional epidemiologic trends in antibiotic resistance in patients with SCI/D may improve appropriate antibiotic prescribing.
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