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Prevalence and Factors Associated With Multidrug-Resistant Gram-Negative Organisms in Patients With Spinal Cord
Charlesnika T Evans1, Margaret A Fitzpatrick1, Makoto M Jones2
11Center of Innovation for Complex Chronic Healthcare (CINCCH),Department of Veterans Affairs,Edward Hines Jr. VA Hospital,Hines,Illinois.
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.
Insights
Multidrug-resistant gram-negative organisms (MDRGNOs) are common in veterans with spinal cord injury or disorder (SCI/D). Healthcare and antibiotic exposure are key factors associated with MDRGNOs, highlighting the need for judicious antibiotic use in this population.
Area of Science:
- Infectious Diseases
- Epidemiology
- Healthcare Management
Background:
- Rising incidence of infections caused by multidrug-resistant gram-negative organisms (MDRGNOs).
- Need to understand MDRGNO prevalence and associated factors in patients with spinal cord injury or disorder (SCI/D).
Purpose of the Study:
- To determine the prevalence of MDRGNOs in patients with SCI/D.
- To identify factors associated with MDRGNO infections in this patient group.
Main Methods:
- Retrospective cohort study analyzing electronic health records from 142 VA facilities.
- Inclusion of 19,642 patients with SCI/D.
- Multivariable cluster-adjusted models used to identify associated factors.
Main Results:
- 41.3% of gram-negative cultures from SCI/D patients were MDRGNOs.
- Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most frequent MDRGNOs.
- Geographic variations in MDRGNO prevalence were observed, with higher rates in the South and Northeast.
Conclusions:
- MDRGNOs are prevalent in both community and healthcare settings for veterans with SCI/D.
- Healthcare exposure and prior antibiotic use are significant risk factors for MDRGNOs.
- Controlling MDRGNO spread in this population requires prioritizing judicious antibiotic stewardship.
