Risk factors for community-associated multidrug-resistant Pseudomonas aeruginosa in veterans with spinal cord injury and disorder: a retrospective cohort study.
METHODS
Retrospective cohort studyObjectives:To identify independent risk factors associated with community-associated multidrug-resistant Psedomonas aeruginosa (MDRPA) in a population of veterans with spinal cord injury and disorders (SCI/D).


METHODS
A total of 127 Veterans Affairs healthcare facilities.


METHODS
Laboratory results from 1 January 2012 to 31 December 2013 were collected, and MDRPA cultures were compared with non-MDRPA cultures.


RESULTS
One thousand four hundred forty-one cultures were collected from Veterans with SCI/D, including 227 cultures with MDRPA isolates. Characteristics associated with an increased odds of MDRPA include age 50-64 (adjusted odds ratio (aOR)=1.80, 95% confidence interval (CI)=1.13-2.87), MDRPA culture in the past 365 days (aOR=9.12, 95% CI=5.88-14.15) and carbapenem exposure in the past 90 days (aOR=2.56, 95% CI=1.35-4.87). In contrast, paraplegia was associated with a 53% decreased odds of MDRPA compared with those with tetraplegia (aOR=0.47, 95% CI=0.32-0.69).


CONCLUSIONS
Risk factors for community-associated MDRPA include prior history of MDRPA and exposure to carbapenems. Awareness of these factors is important for targeted prevention and treatment of MDRPA in patients with SCI/D.
Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA.
I O
IO
Kale
Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA.|Department of Medicine, Division of Infectious Diseases, Loyola University Stritch School of Medicine, Maywood, IL, USA.
M A
MA
Fitzpatrick
Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA.|Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.
K J
KJ
Suda
Department of Veterans Affairs, VA Puget Sound Healthcare System, Seattle, WA, USA.|Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
S P
SP
Burns
Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA.
L
L
Poggensee
Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA.
S
S
Ramanathan
Infectious Disease, Edward Hines Jr VA Hospital, Hines, IL, USA.|Loyola University Medical Center, Maywood, IL, USA.
R
R
Sabzwari
Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, IL, USA.|Center for Healthcare Studies and Department of Preventive Medicine Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
C T
CT
Evans
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011552:Pseudomonas Infections / Q000150:complications / Q000453:epidemiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans