Multi-drug resistant Acinetobacter: Risk factors and Outcomes in Veterans with Spinal Cord Injuries & Disorders

Am J Infect Control, 2017 · DOI: 10.1016/j.ajic.2017.06.016 · Published: November 1, 2017

Spinal Cord Injury Immunology Healthcare

Simple Explanation

Multi-drug resistant Acinetobacter is a growing concern, especially in healthcare settings, and poses a serious threat according to the CDC. Individuals with spinal cord injuries and disorders are at increased risk for infections due to frequent healthcare contact and use of invasive devices. This study aimed to identify risk factors and outcomes of MDR Acinetobacter in Veterans with SCI/D.

Study Duration

2 Years

Participants

571 Veterans with SCI/D

Evidence Level

Retrospective cohort study

Key Findings

1
Inpatient culture, male gender, sputum and other specimen type, receipt of antibiotics within 90 days before culture date, and pressure ulcers were identified as independent predictors of MDR Acinetobacter.
2
The highest odds of MDR Acinetobacter was seen with previous antibiotic use.
3
MDR, previous mechanical ventilation 90 days before the culture, and cancer were all independent risk factors for 30 day mortality.

Research Summary

This study identified risk factors for MDR Acinetobacter and assessed outcomes in Veterans with SCI/D, finding that over half of Acinetobacter cultures were MDR. The greatest risk factor for MDR Acinetobacter was antibiotic exposure in the previous 90 days. MDR Acinetobacter, previous mechanical ventilation, and cancer were independent risk factors for 30-day mortality.

Practical Implications

Antimicrobial Stewardship

Increased efforts should be made to highlight the importance of antimicrobial stewardship to decrease multi-drug resistant infections.

Pressure Ulcer Prevention

Appropriate pressure ulcer prevention and care are crucial in patients with SCI/D to minimize the risk of MDRO colonization and spread.

Infection Control

Improve infection control practices to help limit the spread of Acinetobacter in healthcare settings.

Study Limitations

1
The study did not distinguish between infection and colonization.
2
The retrospective cohort design did not allow separation of factors associated with non-MDR cases and uninfected individuals.
3
The study exclusively used VA data with predominantly male subjects, limiting generalizability to other populations with SCI/D.

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