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Multidrug-resistant Acinetobacter: Risk factors and outcomes in veterans with spinal cord injuries and disorders
Swetha Ramanathan1, Katie J Suda2, Margaret A Fitzpatrick3
1Center of Innovation for Complex Chronic Healthcare, Department of Veterans Affairs, Edward Hines Jr VA Hospital, Hines, IL.
Background:
Multidrug-resistant (MDR) Acinetobacter is a growing concern and has been identified as a serious threat by the Centers for Disease Control and Prevention. However, there is little information on MDR Acinetobacter in individuals with spinal cord injuries and disorders (SCI/Ds). Therefore, the objective of this study was to identify risk factors for, and assess outcomes of, MDR Acinetobacter in veterans with SCI/Ds.
Methods:
This was a retrospective cohort study from January 1, 2012-December 31, 2013, using national Veterans Affairs medical encounter and microbiology data.
Results:
A total of 773 Acinetobacter cultures were identified in 571 patients, of which 58.9% were MDR. Inpatient culture, sputum and other specimen type, receipt of antibiotics within 90 days before culture date, and pressure ulcers were identified as independent predictors of MDR Acinetobacter. Highest odds of MDR Acinetobacter were seen with previous antibiotic use (odds ratio, 7.27; 95% confidence interval, 2.59-20.54). Thirty-day mortality was 5.3% in this study. Multidrug resistance, previous mechanical ventilation 90 days before the culture, and cancer were all independent risk factors for 30-day mortality.
Conclusions:
There should be increased efforts to highlight the importance of antimicrobial stewardship to improve infection control to help limit spread of Acinetobacter in health care settings.
Insights
Multidrug-resistant Acinetobacter infections are common in veterans with spinal cord injuries and disorders. Previous antibiotic use significantly increases the risk of these infections and associated mortality.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Multidrug-resistant (MDR) Acinetobacter poses a significant public health threat.
- Limited data exists on MDR Acinetobacter in individuals with spinal cord injuries and disorders (SCI/Ds).
Purpose of the Study:
- To identify risk factors for MDR Acinetobacter in veterans with SCI/Ds.
- To assess the outcomes associated with MDR Acinetobacter in this population.
Main Methods:
- Retrospective cohort study utilizing national Veterans Affairs medical encounter and microbiology data.
- Data collected from January 1, 2012, to December 31, 2013.
Main Results:
- 58.9% of Acinetobacter cultures were MDR among 571 patients.
- Independent predictors of MDR Acinetobacter included inpatient culture, sputum/other specimen, prior antibiotic use (OR 7.27), and pressure ulcers.
- MDR, prior mechanical ventilation, and cancer were independent risk factors for 30-day mortality (5.3% overall).
Conclusions:
- Antimicrobial stewardship is crucial for improving infection control and limiting Acinetobacter spread in healthcare settings.
- Targeted interventions are needed for high-risk populations like veterans with SCI/Ds.
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