Management of community-acquired pneumonia in persons with spinal cord injury.
METHODS
Retrospective case series.


OBJECTIVE
Respiratory disorders are the leading cause of death in persons with spinal cord injury (SCI), but the epidemiology and medical management of pneumonia in persons with chronic SCI is not well characterized. We describe the clinical presentation of persons with SCI with community-acquired pneumonia (CAP), characterize its management and compare practice to recommendations for CAP in the general population.


METHODS
Three United States Veterans Affairs Medical Centers with specialized SCI services.


METHODS
Chart abstraction was performed for all persons with chronic SCI seen at participating centers for treatment of CAP during a 2-year period. Collected data included presenting signs and symptoms, laboratory and imaging results, initial antibiotic therapy, secretion mobilization techniques, in-patient vs outpatient management, length of stay, and mortality.


RESULTS
In all, 41 persons with SCI received treatment for CAP during the study period. A total of 32 (78.0%) patients were admitted for treatment; two (4.8%) required intubation and mechanical ventilation. Initial antibiotic coverage met guideline recommendations for only half of inpatients and infrequently provided adequate antipseudomonal coverage. Microbiologic testing was performed on 26 cases (63.4%) and demonstrated a specific pathogen in only five cases (12.2% of total). Three cases (7.3%) died during treatment for CAP, and 16 (42.1%) of 38 CAP survivors died within a median follow-up of 3 years.


CONCLUSIONS
The majority of chronic SCI patients who present to specialized SCI centers with CAP are admitted for treatment. Short-term mortality is comparable to CAP in the general population.
Burns
S P
SP
Spinal Cord Injury Service, VA Puget Sound Health Care System, and the Department of Rehabilitation Medicine and Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA.
Weaver
F M
FM
Parada
J P
JP
Evans
C T
CT
Chang
H
H
Hampton
R Y
RY
Kapur
V
V
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D006757:Hospital Units / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000382:microbiology* / Q000401:mortality / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology*; D014481:United States
D000900:Anti-Bacterial Agents