318. Burden and risk factors of multi-drug resistant gram-negative organisms in Veterans with spinal cord injury
Session: Poster Abstract Session: HAI: Multi Drug Resistant Gram Negatives
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Evans 10-16final.pdf (785.4 kB)
  • Background: Multi-drug resistant gram-negative organisms (MDRGNOs) account for a steadily increasing rate of infections in healthcare settings every year. Persons with spinal cord injury (SCI) are at high risk for infections compared to the general patient population due to frequent hospitalization or contact with the health care system and chronic use of invasive medical devices. Therefore, the goal of this study was to describe the prevalence of and risk factors for MDRGNOs in Veterans with SCI.

    Methods: A retrospective cohort study of VA medical encounter data for 19,642 SCI Veterans (1/2012-12/2013). Patients with gram-negative (GN) cultures with antibiotic susceptibility testing were included (removed repeat cultures within 30 days). MDR was defined for each organism as being resistant/intermediate to ≥1 antibiotic in ≥3 antibiotic classes. Multivariable cluster adjusted models were fit to identify factors associated with MDRGNO; adjusted ORs and 95% CIs are presented.

     

    Results: 27,602 GN cultures were identified in 44% (8681/19642) of patients. 48.2% were MDR and the most frequent MDRGNOs were Escherichia coli (35.5%), Proteus mirabilis (14.7%), and Klebsiella pneumoniae (14.1%). Demographic factors associated with an MDRGNO were being age 50-64 (OR=1.50, 1.31-1.72) or 65 years or older (OR=1.48, 1.29-1.69) compared to those <50 years, and having more severe injuries (ie. complete and tetraplegia). Healthcare factors associated with MDRGNOs were use of mechanical ventilation (OR=1.97, 1.53-2.54), antibiotic exposure (OR=1.84, 1.67-2.03), and urinary tract procedures (OR=1.45, 1.15-1.83) in the previous 90 days, and inpatient admission (OR=1.28, 1.18-1.38). Significant variation was seen by U.S. geographic region and VA facility (Figure; larger circles=increased MDRGNO count, red=VA SCI Center).

    Conclusion: MDRGNOs are common with significant variation across regions/facilities in Veterans with SCI. Health care and antibiotic exposures are associated with MDRGNOs. In settings caring for persons with SCI, priority should be given to controlling the spread of MDRGNO bacteria, including a focus on judicious use of antibiotics.  

     

    Figure. MDRGNO isolates in Veterans with SCI, VA facilities 2012-2013

     

    Charlesnika Evans, PhD, MPH1,2, Margaret Fitzpatrick, MD, MS3,4, Linda Poggensee, MS5, Swetha Ramanathan, MPH6, Sherri Lavela, PhD MPH MBA7,8, Stephen Burns, MD9, Makoto Jones, MD, MS10 and Katie J. Suda, PharmD, M.S.1,11, (1)Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, (2)Preventive Medicine and Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, (3)Center of Innovation for Complex Chronic Care, Edward Hines Jr. Veterans Affaris Hospital, Hines, IL, (4)Infectious Diseases, Loyola University Stritch School of Medicine, Maywood, IL, (5)Center of Innovation for Complex Chronic Care, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, (6)Center for Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, (7)Department of Veterans Affairs, Hines, IL, (8)Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, (9)VA Puget Sound Healthcare system, Seattle, WA, (10)Internal Medicine, VA Salt Lake City Health Care System, Salt Lake City, UT, (11)Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago, Chicago, IL

    Disclosures:

    C. Evans, None

    M. Fitzpatrick, None

    L. Poggensee, None

    S. Ramanathan, None

    S. Lavela, None

    S. Burns, None

    M. Jones, None

    K. J. Suda, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.