title: Outcome of bloodstream infections among spinal cord injury patients and impact of multidrug-resistant organisms.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  Our study aimed to describe the outcome of bloodstream infection (BSI) in spinal cord injury (SCI) patients and their associated risk factors for severity and mortality.
  
  
  METHODS
  A French University Hospital.
  
  
  METHODS
  We conducted a retrospective cohort study of all BSIs occurring in hospitalized SCI patients. We analyzed their outcome and risk factors especially the impact of multidrug-resistant organisms (MDROs).
  
  
  RESULTS
  Overall, 318 BSIs occurring among 256 patients were included in the analysis. Mean age was 50.8 years and gender ratio (M/F) was 2.70, with a mean injury duration of 11.6 years.Severity and 30-day mortality of BSI episodes were, respectively, 43.4% and 7.9%. BSI severity was significantly more frequent when caused by respiratory tract infections (RTIs) (odds ratio (OR)=1.38; 95% confidence interval (CI): 1.13-1.44) and significantly lower when caused by urinary tract infections (UTIs) (OR=0.47; 95% CI: 0.28-0.76). BSI mortality was significantly higher when caused by RTIs (OR=3.08; 95% CI: 1.05-8.99), catheter-related bloodstream infections (OR=3.54; 95% CI: 1.36-9.18) or Pseudomonas aeruginosa infections (OR=3.79; 95% CI: 1.14-12.55).MDROs were responsible for 41.2% of all BSI. They have no impact on severity and mortality, whichever be the primary site of infection.In multivariate analysis, mortality was higher when BSI episodes were due to RTIs (OR=3.26; 95% CI: 1.29-8.22) and Pseudomonas aeruginosa infections (OR=3.53; 95% CI: 1.06-11.70), or when associated with immunosuppressive therapy (OR=2.57; 95% CI: 1.14-5.78) or initial severity signs (OR=1.68; 95% CI: 1.01-2.81).
  
  
  CONCLUSIONS
  BSI occurring in SCI population were often severe but mortality remained low. MDROs were frequent but not associated with severity or mortality of BSI episodes. Risk factors associated with mortality were initial severe presentation, RTI, immunosuppressive therapy and BSI due to Pseudomonas aeruginosa.
authors.affiliation: Infectious Diseases Unit, University Hospital Raymond Poincaré, AP-HP, Versailles St Quentin University, Garches, France.
authors.forename: M
authors.initials: M
authors.lastname: Saliba
authors.affiliation: Department of Epidemiology and Biostatistics, Lebanese University, Ecole Doctorale des Sciences et Technologie, Hadath, Lebanon.
authors.forename: D
authors.initials: D
authors.lastname: Saadeh
authors.affiliation: Pharmacy Department, University Hospital Raymond Poincaré, Garches, France.
authors.forename: F
authors.initials: F
authors.lastname: Bouchand
authors.affiliation: Infectious Diseases Unit, University Hospital Raymond Poincaré, AP-HP, Versailles St Quentin University, Garches, France.
authors.forename: B
authors.initials: B
authors.lastname: Davido
authors.affiliation: Infectious Diseases Unit, University Hospital Raymond Poincaré, AP-HP, Versailles St Quentin University, Garches, France.
authors.forename: C
authors.initials: C
authors.lastname: Duran
authors.affiliation: Intensive care Unit, University Hospital Raymond Poincaré, Garches, France.
authors.forename: B
authors.initials: B
authors.lastname: Clair
authors.affiliation: Microbiology Laboratory, University Hospital Raymond Poincaré, Garches, France.
authors.forename: C
authors.initials: C
authors.lastname: Lawrence
authors.affiliation: Intensive care Unit, University Hospital Raymond Poincaré, Garches, France.
authors.forename: D
authors.initials: D
authors.lastname: Annane
authors.affiliation: Physical Medicine and Rehabilitation Unit, University Hospital Raymond Poincaré, Garches, France.
authors.forename: P
authors.initials: P
authors.lastname: Denys
authors.affiliation: Infectious Diseases Unit, University Hospital Raymond Poincaré, AP-HP, Versailles St Quentin University, Garches, France.
authors.forename: J
authors.initials: J
authors.lastname: Salomon
authors.affiliation: Infectious Diseases Unit, University Hospital Raymond Poincaré, AP-HP, Versailles St Quentin University, Garches, France.|Infectious Disease Unit, Bretonneau University Hospital, Tours, France.
authors.forename: L
authors.initials: L
authors.lastname: Bernard
authors.affiliation: Infectious Diseases Unit, University Hospital Raymond Poincaré, AP-HP, Versailles St Quentin University, Garches, France.
authors.forename: A
authors.initials: A
authors.lastname: Dinh
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D015331:Cohort Studies; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects* / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000302:isolation & purification; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents