Changes in bacterial epidemiology and antibiotic resistance among veterans with spinal cord injury/disorder over the past 9 years

Margaret A. Fitzpatrick*, Katie J. Suda, Nasia Safdar, Stephen P. Burns, Makoto M. Jones, Linda Poggensee, Swetha Ramanathan, Charlesnika T. Evans

*Corresponding author for this work

Research output: Contribution to journalArticle

8 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)199-207
Number of pages9
JournalJournal of Spinal Cord Medicine
Volume41
Issue number2
DOIs
StatePublished - Mar 4 2018

Keywords

  • Bacterial
  • Drug resistance
  • Epidemiology
  • Gram-negative bacteria
  • Gram-positive bacteria
  • Spinal cord injury

ASJC Scopus subject areas

  • Clinical Neurology

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