title: Bloodstream infections and setting of onset in persons with spinal cord injury and disorder.
abstract: METHODS
  A retrospective cohort study.
  
  
  OBJECTIVE
  Health-care-associated (HCA) bloodstream infection (BSI) has been shown to be a distinct epidemiologic category in the general adult population, but few studies have examined specific patient populations. The objective of this study was to assess characteristics associated with BSI that occurred in the hospital (hospital-acquired, HA BSI), from health-care contact outside the hospital (HCA BSI) or in the community (community-acquired, CA BSI) in veterans with spinal cord injury and disorder (SCI&D).
  
  
  METHODS
  Two United States Department of Veterans Affairs hospitals.
  
  
  METHODS
  All patients with SCI&D with a positive blood culture admitted to study hospitals over a 7-year period (1 October 1997 to 30 September 2004). Demographics, medical characteristics and causative organisms were collected.
  
  
  RESULTS
  Four hundred and thirteen episodes of BSI occurred in 226 patients, with a rate of 7.2 BSI episodes per 100 admissions: 267 (64.7%) were HA BSI, 110 (26.6%) were HCA BSI and 36 (8.7%) were CA BSI. Antibiotic resistance was more common in those with HA BSI (65.5%) compared with that in those with HCA (49.1%, P=0.001) and CA BSI (22.2%, P<0.0001). Methicillin resistance in Staphylococcus aureus was highly prevalent; HA BSI (84.5%), HCA BSI (60.6%) and CA BSI (33.3%).
  
  
  CONCLUSIONS
  HCA BSI comprises one-quarter of all BSIs in hospitalized patients with SCI&D. Although those with HCA and CA BSI share similarities, several differences in medical characteristics and causal microorganism are noted. Treatment and management strategies for HCA and CA infections need to vary.
authors.affiliation: Department of Veterans Affairs, Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA. Charlesnika.Evans@va.gov
authors.forename: C T
authors.initials: CT
authors.lastname: Evans
authors.forename: R C
authors.initials: RC
authors.lastname: Hershow
authors.forename: A
authors.initials: A
authors.lastname: Chin
authors.forename: P R
authors.initials: PR
authors.lastname: Foulis
authors.forename: S P
authors.initials: SP
authors.lastname: Burns
authors.forename: F M
authors.initials: FM
authors.lastname: Weaver
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology*; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000209:etiology; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*