Pa predominantly affects patients with immunosuppression and underlying comorbidities, results in severe illness, and is associated with poor clinical outcomes. Patients with SCI may represent a distinct group at risk for Pa infections. We conducted a case-control study to compare patients with and without SCI infected or colonized with Pa who were seen at a VA SCI referral center.
Cases were defined as patients with SCI in whom Pa was isolated from clinical specimens (urine, blood, sputum, wounds, etc.) at the Cleveland VA from December 2011 through February 2014. Controls were randomly selected from patients without SCI in whom Pa was isolated during the same timeframe. Medical records were reviewed to determine demographics, colonization vs. infection, time between admission and isolation, antibiotic resistance, treatment and survival. Comorbidities were assessed with Charlson index, and severity of underlying illness with McCabe-Jackson score.
62 patients with SCI were included as cases, and 123 patients without SCI were included as controls. Cases were younger(61.5 vs 71 years, respectively) and had fewer comorbidities, even after controlling for age (Charlson index of 4.34 vs. 7.62). Colonization was more frequent than infection (2.55 vs. 1.76 isolates/patient; 0.95 infections/patient in both groups) and acquisition of Pa during hospital admission was more frequent in cases than controls (80% vs. 53%). Higher rates of carbapenem-resistance occurred in cases (34% vs. 18%), and there was less frequent use of carbapenems. Underlying illness was less severe and survival better among SCI patients.
In this case-control study, we identify patients with SCI as a unique population of patients that are colonized frequently with Pa. Other than disability due to SCI, there does not seem to be significant co-morbidities, and outcomes were favorable. These data suggest that antibiotic use and infection control practices need to be optimized for SCI patients.
R. A. Bonomo, None
F. Perez, None