Predictors and Outcomes of Antibiotic Adequacy for Bloodstream Infections in Veterans With Spinal Cord Injury
Presented in part as a poster to the American Paraplegia Society, August 27–29, 2007, Orlando, FL.
Abstract
Evans CT, Burns SP, Chin A, Weaver FM, Hershow RC. Predictors and outcomes of antibiotic adequacy for bloodstream infections in veterans with spinal cord injury.
Objective
To identify predictors and outcomes associated with receiving inadequate empirical antimicrobial treatment for bloodstream infections (BSIs) in persons with spinal cord injury (SCI).
Design
Retrospective cohort study from October 1, 1997, through September 30, 2004.
Setting
A Department of Veterans Affairs SCI center that serves approximately 700 patients a year.
Participants
Hospitalized patients with SCI (N=123) who had 1 or more BSIs during the study period.
Interventions
Not applicable.
Main Outcome Measures
Adequacy of antimicrobial treatment (inadequate treatment was defined as the absence of antimicrobial agents for a particular organism within 2 days after the collection of blood cultures and/or the microorganism's resistance to the antimicrobial administered), hospital length of stay (LOS) post-BSI infection, and in-hospital and 30-day mortality. Cluster-adjusted multivariable models were assessed.
Results
Over one third (88; 37.4%) of the 235 episodes of BSI identified received inadequate empirical antibiotic treatment. Having a polymicrobial BSI was associated with inadequate treatment (odds ratio [OR]=3.28; 95% confidence interval [CI]=1.62–6.65; P=.001). Factors protective against inadequate therapy included having a comorbid pressure ulcer (OR=0.37; 95% CI=0.21–0.68; P=.001) or a BSI that was not primary (OR=0.30; 95% CI=0.15–0.58; P<.0001). Mortality did not differ between the inadequate and adequate treatment groups (11.4% vs 10.9%; P=.92). Similarly LOS postinfection was not affected by treatment status (inadequate treatment median=22d vs adequate treatment median=27d; P=.98).
Conclusions
Over one third of patients received inadequate empirical treatment, which was associated with having a polymicrobial BSI. However, inadequate treatment was not associated with increased mortality or LOS postinfection.
aDepartment of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Center for Management of Complex Chronic Care, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL
bInstitute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL
cDepartment of Neurology, Northwestern University, Chicago, IL
dUniversity of Washington and Veterans Affairs Puget Sound Health Care System, Seattle, WA
eSchool of Public Health, Department of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL
Reprint requests to Charlesnika T. Evans, MPH, PhD, Edward J. Hines Jr. VA Hospital (151H), 5th Ave and Roosevelt Rd, PO Box 5000, Room D302, Hines, IL 60141
Supported by the Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development Service (grant no. SCI 98-000). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
ABSTRACT