title: Infections in the spinal cord-injured population: a systematic review.
abstract: METHODS
  Spinal cord injury (SCI) patients are an increasing population due to recent military conflicts. SCI patients are at an increased risk of infection, but the epidemiology management and prevention strategies for these infections are unclear.
  
  
  OBJECTIVE
  To review the incidence, microbiology and management of pneumonia, skin and soft tissue infections (SSTI), urinary tract infections (UTI) and bloodstream infections in the SCI population via literature review.
  
  
  METHODS
  With the assistance of an experienced medical librarian, we developed a search strategy for the Ovid MEDLINE database and then adapted it for the Ovid Embase, Scopus and Web of Science databases. The databases were searched from their inception to April 2014 with no restrictions on language or time period. Data were extracted using a standardized form. All studies were reviewed by two independent investigators.
  
  
  RESULTS
  Forty-one studies reporting on the described infections were identified. UTIs were the most commonly identified infections, but studies failed to identify consistently effective preventive strategies. SSTIs were also common, and the best preventive strategies focused on decubitus ulcer prevention and skin decolonization protocols. Pneumonia management and course were not significantly different from the general population. Bloodstream infections were associated with delays in recognition, and were most often secondary to UTI, pneumonia or SSTI.
  
  
  CONCLUSIONS
  There is a paucity of literature on consistently effective infection prevention strategies in SCI patients. Identification and implementation of evidence-based interventions that optimize prevention and management of infections in this patient population are needed.
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.|Multidisciplinary Epidemiology and Translational Research in Critical Care (METRIC) Group, Mayo Clinic, Rochester, MN, USA.
authors.forename: L Y
authors.initials: LY
authors.lastname: Garcia-Arguello
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Critical Care (METRIC) Group, Mayo Clinic, Rochester, MN, USA.|Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: O'Horo
authors.affiliation: Department of Library Services, Mayo Clinic, Rochester, MN, USA.
authors.forename: A
authors.initials: A
authors.lastname: Farrell
authors.affiliation: Center of Innovation for Complex Chronic Healthcare and Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, Hines, IL, USA.|Department of Preventive Medicine and Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: R
authors.initials: R
authors.lastname: Blakney
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Sohail
authors.affiliation: Center of Innovation for Complex Chronic Healthcare and Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, Hines, IL, USA.|Department of Preventive Medicine and Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: C T
authors.initials: CT
authors.lastname: Evans
authors.affiliation: Department of Medicine, Section of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.|William S. Middleton Veterans Affairs Hospital, Madison, WI, USA.
authors.forename: N
authors.initials: N
authors.lastname: Safdar
mesh_terms: D006801:Humans; D007239:Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy*; D013119:Spinal Cord Injuries / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy*