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. 2020 May;58(5):596-608.
doi: 10.1038/s41393-019-0393-y. Epub 2019 Dec 11.

Multidrug-resistant gram-negative organisms and association with 1-year mortality, readmission, and length of stay in Veterans with spinal cord injuries and disorders

Swetha Ramanathan  1 , Margaret A Fitzpatrick  2   3 , Katie J Suda  4   5 , Stephen P Burns  6   7 , Makoto M Jones  8   9 , Sherri L LaVela  2   10 , Charlesnika T Evans  2   11
Affiliations

Multidrug-resistant gram-negative organisms and association with 1-year mortality, readmission, and length of stay in Veterans with spinal cord injuries and disorders

Swetha Ramanathan et al. Spinal Cord. 2020 May.

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.

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Conflict of interest statement

Conflicts of Interest

The authors report no conflicts of interest.

Figures

Figure 1.
Figure 1.. Proportion of inpatients, outpatients, and LTC individuals that received the type of antibiotic 90-days before and association with outcomes of mortality, readmission, and length of stay
* Denotes unadjusted OR or unadjusted IRR were significant and the proportion of those that received the specific antibiotic were different among those that died and did not die ○ Denotes unadjusted OR was significant and the proportion of those that received the specific antibiotic were different among those that were readmitted and were not readmitted † Denotes unadjusted IRR was significant and the length of stay differed for those that received the specific antibiotic compared to those that did not
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. Available from: https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-201.... Accessed March 7, 2019.
    1. Weiner LM, Webb AK, Limbago B, Dudeck MA, Patel J, Kallen AJ, Edwards JR, Sievert DM. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011–2014. Infect Control Hosp Epidemiol 2016; 37(11):1288–1301. - PMC - PubMed
    1. Montgomerie JZ. Infections in patients with spinal cord injuries. Clin Infect Dis 313 1997;25:1285–90. - PubMed
    1. Evans CT, LaVela SL, Weaver FM, Priebe M, Sandford P, Niemiec S, et al. Epidemiology of hospital-acquired infections in veterans with spinal cord injury and disorder. Infect Control Hosp Epidemiol 2008;29:234–42. - PubMed
    1. Fitzpatrick MA, Suda KJ, Safdar N, Goldstein B, Jones MM, Poggensee L, et al. Unique risks and clinical outcomes associated with extended-spectrum betalactamase Enterobacteriaceae in veterans with spinal cord injury/disorder: a case-case-control study. Infect Control Hosp Epidemiol 2016;37:768–76. - PMC - PubMed