Abstract
Study design:
Retrospective observational study of bacterial susceptibilities in Veterans with SCI/D as compared to a general patient population.
Objectives:
The purpose of this project was to evaluate the prevalence and susceptibility of bacteria isolated from spinal cord injury and disorder (SCI/D) patients as compared with a general patient population and determine whether a SCI/D-specific antibiogram, a report of bacterial susceptibilities used to guide empiric antibiotic selection, would be a useful stewardship tool.
Setting:
Veterans Affairs Medical Center located in Cook county, IL, USA.
Methods:
Microbiology reports from 1 October 2012 to 30 September 2013 were compiled into a SCI/D-specific antibiogram and compared to a non-SCI/D antibiogram.
Results:
Persons with positive cultures and SCI/D were younger and had a higher Charlson Index as compared to non-SCI/D patients (P<0.0001 for both). Five thousand one hundred and thirty-one unique isolate cultures were evaluated (SCI/D=23.0%). Frequencies of pathogens isolated in SCI/D and non-SCI/D differed. Methicillin-resistant Staphylococcus aureus occurred more frequently in SCI/D (27.8% vs 55.4%; P<0.0001). Gram-negatives had generally lower susceptibilities in SCI/D and a higher frequency of organisms producing extended-spectrum Beta-lactamases (17.6% vs 5.0%; P<0.0001), carbapenem-resistant Enterobacteriaceae (2.4% vs 0.5%; P<0.0001), carbapenem resistance (7.6% vs 2.4%; P<0.0001) and isolates resistant to ⩾3 antibiotic classes (60.7% vs 28.0%; P=0.0001).
Conclusion:
Different pathogens with poorer susceptibilities are isolated in SCI/D. Thus an SCI/D-specific antibiogram reflective of resistance patterns in these patients may increase the appropriateness of empiric antibiotic selection. The frequency of multi-drug resistant organisms in cultures obtained from patients with SCI/D is worrisome.
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Acknowledgements
The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the Health Services Research and Development Service or the United States government. This work was supported by the US Department of Veterans Affairs as a QUERI center grant (SCI 98-001) and QUERI LIP (QLP 97-009).
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This project was presented, in part, as a poster at the Infectious Disease Society of America Annual Meeting in Philadelphia, PA, USA, October 2014.
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Suda, K., Patel, U., Sabzwari, R. et al. Bacterial susceptibility patterns in patients with spinal cord injury and disorder (SCI/D): an opportunity for customized stewardship tools. Spinal Cord 54, 1001–1009 (2016). https://doi.org/10.1038/sc.2016.38
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DOI: https://doi.org/10.1038/sc.2016.38
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