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Changes in bacterial epidemiology and antibiotic resistance among veterans with spinal cord injury/disorder over the past 9 years |
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| Authors: | Margaret A Fitzpatrick Katie J Suda Nasia Safdar Stephen P Burns Makoto M Jones Linda Poggensee |
| Institution: | 1. Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, Illinois, USA;2. Department of Medicine, Division of Infectious Diseases, Loyola University Stritch School of Medicine, Maywood, Illinois, USA;3. Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA;4. Department of Veterans Affairs, William S. Middleton VA Medical Center, Madison, Wisconsin, USA;5. Department of Medicine, Division of Infectious Diseases, University of Wisconsin, Madison, Wisconsin, USA;6. Department of Veterans Affairs, VA Puget Sound Healthcare System, Seattle, Washington, USA;7. Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA;8. Department of Veterans Affairs, VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA;9. Department of Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah, 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. |
| Keywords: | Spinal cord injury Drug resistance Bacterial Epidemiology Gram-negative bacteria Gram-positive bacteria |