1809. Healthcare and Antibiotic Exposures Increase Risk of Extended-Spectrum Beta-Lactamase Enterobacteriaceae in Veterans with Spinal Cord Injury: A Case-Case-Control Study
Session: Poster Abstract Session: Resistant Gram-Negative Infections: Epidemiology
Saturday, October 10, 2015
Room: Poster Hall

Patients with spinal cord injury/disease (SCI/D) may have an increased risk for infection with multidrug resistant organisms. This study describes the burden of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae in Veterans with SCI/D, identifies risk factors for ESBL acquisition, and assesses the impact of ESBL status on outcomes.


This was a retrospective case-case-control study of Veterans with SCI/D from January 1, 2012 – December 31, 2013. Cases were patients with a first positive culture for ESBL Klebsiella pneumoniae, Escherichia coli, or Proteus mirabilis. For inpatients and residents of long-term care (LTC), cases were matched to: 1) a second case group of patients with a positive culture for susceptible organisms and matched by organism, facility, level of care (inpatient vs. LTC), and time at risk; and, 2) uninfected controls matched by facility, level of care, and time at risk. Outpatients were matched similarly, with the exclusion of time at risk. Cluster-adjusted univariate and multivariable models were created to identify factors associated with ESBL acquisition and its impact on outcomes.


A total of 503 cases were matched 1:1 with both comparison groups (n=1509). Outpatients accounted for 61.2% of the cohort. ICU admission (OR 2.89, 95% CI 1.56-5.34, p=0.001), 3rdgeneration cephalosporins (OR 4.14, 95% CI 1.57-10.93, p=0.004), quinolones (OR 2.99, 95% CI 1.98-4.52, p<0.0001), and nitrofurantoin (OR 2.10, 95% CI 1.11-3.99, p=0.02) in the prior 90 days were independently associated with ESBL compared to non-ESBL (and controls) in the multivariable adjusted models. Although there were no significant differences in mortality between groups, inpatients with ESBL had significantly greater 30-day hospital readmissions (OR 2.38, 95% CI 1.20-4.73, p=0.01) than controls.


Colonization or infection with ESBL organisms is common in the SCI/D population, especially among outpatients. Antibiotic use is a risk factor for ESBL organisms, thus antimicrobial stewardship programs encouraging judicious use of antibiotics in SCI/D patients are critical. Infection prevention efforts should consider screening for ESBL colonization in SCI/D patients in ICUs or with recent healthcare exposure.

Margaret Fitzpatrick, MD, MS1, Katie J. Suda, PharmD2, Nasia Safdar, MD, PhD, FSHEA3, Barry Goldstein, MD, PhD4, Makoto Jones, MD, MS5, Linda Poggensee, MS6, Swetha Ramanathan, MPH2, Ryan Lewan, PharmD7 and Charlesnika Evans, PhD, MPH8, (1)Center of Innovation for Complex Chronic Care, Edward Hines Jr. Veterans Affaris Hospital, Hines, IL, (2)Center for Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, (3)William S. Middleton Memorial Veterans Hospital, Madison, WI, (4)Veterans Affairs Puget Sound Healthcare System, Seattle, WA, (5)Ideas Center, VA Salt Lake City Health Care System, Salt Lake City, UT, (6)Center of Innovation for Complex Chronic Care, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, (7)Pharmacy, Edward Hines, Jr. VA Hospital, Hines, IL, (8)Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL


M. Fitzpatrick, None

K. J. Suda, None

N. Safdar, None

B. Goldstein, None

M. Jones, None

L. Poggensee, None

S. Ramanathan, None

R. Lewan, None

C. Evans, None

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