Risk factors for community-associated multidrug resistant Pseudomonas aeruginosa in Veterans with spinal cord injury and disorder: a retrospective cohort study

Spinal Cord, 2017 · DOI: 10.1038/sc.2017.7 · Published: July 1, 2017

Spinal Cord Injury Immunology Healthcare

Simple Explanation

This study investigated risk factors for community-associated multidrug-resistant Pseudomonas aeruginosa (MDRPA) infections in Veterans with spinal cord injuries and disorders (SCI/D). MDRPA is a type of bacteria that is resistant to many antibiotics, making it difficult to treat. The researchers analyzed data from over 1,000 Veterans with SCI/D and compared those who had MDRPA infections to those who had infections with non-resistant strains of Pseudomonas aeruginosa. The study looked at factors like age, level of spinal cord injury, previous infections, and antibiotic use. The findings indicated that certain factors, such as previous MDRPA infections, exposure to carbapenem antibiotics, and age between 50-64, were associated with an increased risk of community-associated MDRPA infections in this population. Paraplegia was associated with a decreased risk compared to tetraplegia.

Study Duration

2 Years

Participants

1144 Veterans with spinal cord injury and disorders (SCI/D)

Evidence Level

Retrospective cohort study

Key Findings

1
Patients aged 50-64 years had a significantly higher risk of MDRPA compared to younger patients (18-49 years).
2
Patients with paraplegia had a lower risk of MDRPA compared to patients with tetraplegia.
3
A previous MDRPA culture in the past year was a strong predictor of a positive MDRPA culture.

Research Summary

This retrospective cohort study identified risk factors associated with community-associated multidrug resistant Pseudomonas aeruginosa (MDRPA) in Veterans with spinal cord injury and disorders (SCI/D). The study found that age, level of spinal cord injury, prior MDRPA isolation, and prior antibiotic exposure are associated with community-associated MDRPA colonization and infection. Awareness of these risk factors is crucial for targeted prevention and treatment strategies to combat MDRPA infections in this vulnerable patient population.

Practical Implications

Targeted Prevention Strategies

Implement tailored prevention measures for Veterans with SCI/D who have risk factors such as prior MDRPA infections or recent carbapenem use.

Antibiotic Stewardship

Promote judicious use of carbapenems and other broad-spectrum antibiotics to reduce the selective pressure for MDRPA.

Risk Stratification

Stratify SCI/D patients based on their risk of MDRPA to guide screening and empiric treatment decisions.

Study Limitations

1
The study does not account for Veterans who seek healthcare outside of the VA system.
2
The study lacks differentiation between colonization and true infection with P. aeruginosa.
3
Strain type information for P. aeruginosa was unavailable in the administrative datasets.

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