Multidrug-resistant gram-negative organisms and association with 1-year mortality, re-admission, and length of stay in Veterans with spinal cord injuries and disorders

Spinal Cord, 2020 · DOI: 10.1038/s41393-019-0393-y · Published: May 1, 2020

Spinal Cord Injury Immunology Healthcare

Simple Explanation

This study looked at the impact of multi-drug resistant gram-negative organisms (MDRGNOs) on outcomes in individuals with spinal cord injury or disorder (SCI/D). MDRGNOs are bacteria that are resistant to many common antibiotics, making them difficult to treat. The researchers analyzed data from over 8,000 veterans with SCI/D and found that MDRGNO infections were associated with increased mortality in outpatients and long-term care patients. MDRGNO infections also led to longer hospital stays for inpatients. The findings suggest that preventing infections and managing antibiotic use are important in this population. Further research is needed to understand why MDRGNOs have such a significant impact on outcomes in people with SCI/D.

Study Duration

January 1, 2011-December 31, 2013

Participants

8,681 individuals with SCI/D

Evidence Level

Retrospective cohort study

Key Findings

1
MDRGNOs are prevalent in SCI/D, with 33.0% of the 8,681 individuals having a MDRGNO.
2
MDR was associated with increased 1-year mortality among outpatients (IRR: 1.28, 95% CI, 1.06–1.54) and long-term care patients (OR: 2.06, 95% CI, 1.28–3.31).
3
MDR significantly impacted post-culture LOS in inpatients, as evidenced by a 10% longer LOS in MDR vs. non-MDR (IRR: 1.10, 95%CI, 1.02–1.19).

Research Summary

This study assessed the impact of multidrug-resistant gram-negative organisms (MDRGNOs) on outcomes in individuals with spinal cord injury/disorder (SCI/D). The results showed that having an MDRGNO culture was associated with increased risk and increased odds for 1-year mortality among outpatients and LTC patients, respectively. The study supports increased attention to antibiotic stewardship in SCI/D populations to prevent antibiotic resistance and effective infection prevention strategies to prevent MDRGNOs transmission.

Practical Implications

Antibiotic Stewardship Programs

Implement and reinforce antibiotic stewardship programs within SCI/D care settings to curb the development and spread of antibiotic-resistant bacteria.

Infection Prevention Strategies

Enhance and strictly enforce infection prevention protocols, particularly in outpatient and long-term care environments, to minimize the transmission of MDRGNOs among vulnerable SCI/D patients.

Targeted Interventions

Develop and deploy targeted interventions aimed at reducing healthcare exposures for outpatients with SCI/D, addressing potential chronic conditions and prior antibiotic use that may elevate mortality risk.

Study Limitations

1
The study did not distinguish between infection and colonization, especially with urinary colonization.
2
The study did not capture data from healthcare external to the VA, which may bias results.
3
The results may not be generalizable to other populations with SCI/D because the study focused on Veterans with SCI/D who receive care at the VA and are mostly male.

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