Effective antibiotic stewardship in spinal cord injury: Challenges and a way forward

The Journal of Spinal Cord Medicine, 2019 · DOI: 10.1080/10790268.2017.1396183 · Published: April 1, 2019

Simple Explanation

Antibiotic stewardship is crucial for reducing antibiotic misuse and resistance, especially for individuals with spinal cord injuries (SCI/D) who often require multiple antibiotic courses due to frequent healthcare exposure and high rates of multi-drug resistant bacterial infections. Unique challenges in evaluating antibiotic use in SCI/D patients include bacterial colonization in the urine and differing infection signs and symptoms. VHA facilities with SCI/D centers generally possess more antibiotic stewardship resources, potentially leading to reduced antibiotic use, but effective implementation tailored to this specific patient care setting is the next critical step.

Study Duration

Not specified

Participants

VHA facilities with SCI/D (n=23) versus non-SCI/D facilities (n=107)

Evidence Level

Not specified

Key Findings

1
VHA facilities with SCI/D centers are more likely to have components of an antibiotic stewardship program that have led to reduced antibiotic use in previous studies.
2
Facilities with SCI/D centers are more likely to have personnel with infectious diseases training.
3
SCI/D center facilities were also more likely to have policies for de-escalation of antibiotics and clinical guidelines for specific conditions.

Research Summary

VHA facilities with SCI/D centers are more likely to be staffed with key players of antibiotic stewardship programs, be a part of academic/training institutions, and have more antibiotic restriction policies than non-SCI/D center VA facilities. Effective antibiotic stewardship programs reduce antibiotic use, and SCI/D providers are receptive to filling gaps in their knowledge about available resources. The pieces are in place to develop SCI/D-focused antibiotic stewardship programs to address the threat that highly resistant organisms pose to the health of the SCI/D patient population.

Practical Implications

Targeted Stewardship Programs

Develop and implement SCI/D-focused antibiotic stewardship programs to combat highly resistant organisms.

Resource Utilization

Encourage SCI/D care providers to actively use available antibiotic stewardship resources, such as facility antibiograms and ID consult services.

Policy Implementation

Reinforce and expand antibiotic restriction policies in SCI/D centers to promote judicious antibiotic use.

Study Limitations

1
The study relies on survey data, which may be subject to recall bias or inaccuracies in self-reporting.
2
The study focuses on VHA facilities, limiting the generalizability of the findings to other healthcare settings.
3
Further study is needed to correlate antibiotic use in SCI/D specific care and the presence of specific antibiotic stewardship resources and policies.

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