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.
N. Safdar, None
B. Goldstein, None
M. Jones, None
L. Poggensee, None
S. Ramanathan, None
R. Lewan, None
C. Evans, None