title: Use of antibiotic and prevalence of antibiotic-associated diarrhoea in-patients with spinal cord injuries: a UK national spinal injury centre experience.
abstract: BACKGROUND
  This was a retrospective audit, with the aims being to (1) record the use of antibiotics; (2) establish the prevalence of antibiotic-associated diarrhoea (AAD) and Clostridium difficile-associated diarrhoea (CDAD); and (3) assess if there was any seasonal variation in antibiotic use and incidence of AAD.
  
  
  METHODS
  The study was performed at a single spinal cord injury (SCI) centre in the UK. Data were collected using a standardised questionnaire during October 2014 to June 2015. We define AAD as two or more watery stools of type 5, 6 or 7 (Bristol stool scale) over 24 h.
  
  
  RESULTS
  Three-hundred-and-nineteen adults (mean age: 55.9 years, 29.2% female) with SCI (58.2% tetraplegia; 43.7% complete SCI) were included. Of 70 (21.9%) patients on antibiotics, the top three indications for antibiotics were urinary-tract infections, infected pressure ulcers and other skin infections. Seventeen of 78 (21.8%) developed AAD and three of 319 (0.94%) developed CDAD. AAD was more common in the summer season than in spring, autumn and winter (47.1%, 10.0%, 10.0%, 23.8%, P=0.025). AAD was associated with older adults greater than 65 years (70.6% vs 23.8%, P=0.007). Polypharmacy and the summer season were identified as independent predictors for AAD.
  
  
  CONCLUSIONS
  This survey found that AAD is common in SCI patients and may be a risk factor for a poorer outcome and increased hospital costs. A multicentre study is underway to establish the incidence and risk factors for AAD.
authors.affiliation: National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK.|School of Health Science, City University, London, UK.
authors.forename: S
authors.identifier: http://orcid.org/0000-0002-3975-5684
authors.initials: S
authors.lastname: Wong
authors.affiliation: National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK.
authors.forename: P
authors.initials: P
authors.lastname: Santullo
authors.affiliation: Department of Microbiology, Stoke Mandeville Hospital, Aylesbury, UK.
authors.forename: J
authors.initials: J
authors.lastname: O'Driscoll
authors.affiliation: Royal Buckinghamshire Hospital, Aylesbury, UK.
authors.forename: A
authors.initials: A
authors.lastname: Jamous
authors.affiliation: School of Health Science, City University, London, UK.
authors.forename: S P
authors.initials: SP
authors.lastname: Hirani
authors.affiliation: National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK.
authors.forename: M
authors.initials: M
authors.lastname: Saif
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000139:chemically induced / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007239:Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019338:Polypharmacy; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D013119:Spinal Cord Injuries / Q000150:complications / Q000453:epidemiology* / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents