Bloodstream Infections in Veterans with Spinal Cord Injury May Require Different Treatment Strategies
Bloodstream infections (BSIs) are a common type of infection in people with spinal cord injury (SCI). Risk factors for hospital-acquired and community-acquired BSI have been well described in the general population. Bloodstream infections that occur in healthcare settings (e.g., acute care, long-term care) have been traditionally classified as community-acquired, but recent evidence suggests that these infections are distinct and may have a unique epidemiology. This retrospective review assessed characteristics associated with bloodstream infections that were: hospital-acquired (HA BSI), from healthcare contact outside the hospital (HCA BSI), or were community-acquired (CA BSI). Investigators assessed clinical data for Veterans with SCI admitted to two VA tertiary care hospitals over seven years (10/1/97 -- 9/30/04).
Results show that HCA bloodstream infections accounted for 25% of all BSIs in hospitalized Veterans with spinal cord injury. Over the seven-year study period, 413 episodes of BSI occurred in 226 Veterans, with a rate of 7.2 BSI episodes per 100 admissions. Of these episodes, 64.7% were HA BSI, 26.6% were HCA BSI, and 8.7% were CA BSI. Antibiotic resistance was more common in Veterans with HA BSI (65.5%) compared to those with HCA (49.1%) and CA BSI (22.2%). Methicillin-resistance in Staphylococcus aureus (MRSA) was highly prevalent: 84.5% in Veterans with HA BSI, 60.6% in Veterans with HCA BSI, and 33.3% in Veterans with CA BSI. Because several differences in medical characteristics and causal micro-organisms were found, the authors suggest that treatment and management strategies for HCA and CA infections may need to vary.
Evans C, Hershow R, Chin A, Foulis P, Burns S, and Weaver F. Bloodstream infections and setting of onset in persons with spinal cord injury and disorder. Spinal Cord August 2009;47(8):610-615.
This study was funded by HSR&D. Drs. Evans and Weaver and Ms. Chin are part of VA/HSR&D’s Spinal Cord Injury Quality Enhancement Research Initiative (SCI-QUERI).