Swetha Ramanathan1, Margaret A Fitzpatrick2,3, Katie J Suda4,5, Stephen P Burns6,7, Makoto M Jones8,9, Sherri L LaVela2,10, Charlesnika T Evans2,11. 1. Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL, USA. swetha.ramanathan@va.gov. 2. Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL, USA. 3. Department of Internal Medicine, Stritch School of Medicine, Loyola University, Chicago, IL, USA. 4. Center for Health Equity Research and Promotion, Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. 5. School of Medicine, Department of Medicine, University of Pittsburgh, Pittsburg, PA, USA. 6. Spinal Cord Injury Service, Department of Veterans Affairs, VA Puget Sound Health Care System, Seattle, WA, USA. 7. Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA. 8. Department of Veterans Affairs, VA Salt Lake City Healthcare System, Salt Lake City, UT, USA. 9. Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA. 10. Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. 11. Department of Preventive Medicine and Center for Health Care Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Abstract
STUDY DESIGN: Retrospective cohort study. OBJECTIVES: The goal of this study was to assess the impact of multidrug resistant gram-negative organisms (MDRGNOs) on outcomes in those with SCI/D. SETTING: VA SCI System of Care, Department of Veterans Affairs, United States. METHODS: Multidrug resistance (MDR) was defined as being non-susceptible to ≥1 antibiotic in ≥3 antibiotic classes. Multivariable cluster-adjusted regression models were fit to assess the association of MDRGNOs with 1-year mortality, 30-day readmission, and postculture length of stay (LOS) stratified by case setting patients. Only the first culture per patient during the study period was included. RESULTS: A total of 8,681 individuals with SCI/D had a culture with gram-negative bacteria during the study period, of which 33.0% had a MDRGNO. Overall, 954 (10.9%) died within 1 year of culture date. Poisson regression showed that MDR was associated with 1-year mortality among outpatients (IRR: 1.28, 95% CI, 1.06-1.54) and long-term care patients (OR: 2.06, 95% CI, 1.28-3.31). MDR significantly impacted postculture LOS in inpatients, as evidenced by a 10% longer LOS in MDR vs. non-MDR (IRR: 1.10, 95% CI, 1.02-1.19). MDR was not associated with increased 30-day readmission. CONCLUSIONS: MDRGNOs are prevalent in SCI/D and MDR may result in poor outcomes. Further attention to prevention of infections, antibiotic stewardship, and management are warranted in this population.
STUDY DESIGN: Retrospective cohort study. OBJECTIVES: The goal of this study was to assess the impact of multidrug resistant gram-negative organisms (MDRGNOs) on outcomes in those with SCI/D. SETTING: VA SCI System of Care, Department of Veterans Affairs, United States. METHODS: Multidrug resistance (MDR) was defined as being non-susceptible to ≥1 antibiotic in ≥3 antibiotic classes. Multivariable cluster-adjusted regression models were fit to assess the association of MDRGNOs with 1-year mortality, 30-day readmission, and postculture length of stay (LOS) stratified by case setting patients. Only the first culture per patient during the study period was included. RESULTS: A total of 8,681 individuals with SCI/D had a culture with gram-negative bacteria during the study period, of which 33.0% had a MDRGNO. Overall, 954 (10.9%) died within 1 year of culture date. Poisson regression showed that MDR was associated with 1-year mortality among outpatients (IRR: 1.28, 95% CI, 1.06-1.54) and long-term care patients (OR: 2.06, 95% CI, 1.28-3.31). MDR significantly impacted postculture LOS in inpatients, as evidenced by a 10% longer LOS in MDR vs. non-MDR (IRR: 1.10, 95% CI, 1.02-1.19). MDR was not associated with increased 30-day readmission. CONCLUSIONS: MDRGNOs are prevalent in SCI/D and MDR may result in poor outcomes. Further attention to prevention of infections, antibiotic stewardship, and management are warranted in this population.
Authors: Amanda Vivo; Margaret A Fitzpatrick; Katie J Suda; Makoto M Jones; Eli N Perencevich; Michael A Rubin; Swetha Ramanathan; Geneva M Wilson; Martin E Evans; Charlesnika T Evans Journal: BMC Infect Dis Date: 2022-05-24 Impact factor: 3.667