title: Changes in bacterial epidemiology and antibiotic resistance among veterans with spinal cord injury/disorder over the past 9 years.
abstract: Patients with spinal cord injury and disorder (SCI/D) have an increased risk of infection with multidrug-resistant (MDR) bacteria. We described bacterial epidemiology and resistance in patients with SCI/D at Veterans Affairs Medical Centers (VAMCs) for the past 9 years.
  
  
  
  Retrospective cohort.
  
  
  
  One hundred thirty VAMCs.
  
  
  
  Veterans with SCI/D and bacterial cultures with antibiotic susceptibility testing performed between 1/1/2005-12/31/2013. Single cultures with contaminants and duplicate isolates within 30 days of initial isolates were excluded.
  
  
  
  None.
  
  
  
  Trends in microbial epidemiology and antibiotic resistance.
  
  
  
  Included were 216,504 isolates from 19,421 patients. Urine was the most common source and Gram-negative bacteria (GNB) were isolated most often, with 36.1% of GNB being MDR. Logistic regression models clustered by patient and adjusted for location at an SCI/D center and geographic region showed increased odds over time of vancomycin resistance in Enterococcus [adjusted odds ratio (aOR) 1.67, 95% confidence interval (CI) 1.30-2.15], while methicillin resistance in Staphylococcus aureus remained unchanged (aOR 0.90, 95% CI 0.74-1.09). There were also increased odds of fluoroquinolone resistance (aOR 1.39, 95% CI 1.31-1.47) and multidrug resistance (aOR 1.46, 95% CI 1.38-1.55) in GNB, with variability in the odds of MDR bacteria by geographic region.
  
  
  
  GNB are isolated frequently in Veterans with SCI/D and have demonstrated increasing resistance over the past 9 years. Priority should be given to controlling the spread of resistant bacteria in this population. Knowledge of local and regional epidemiologic trends in antibiotic resistance in patients with SCI/D may improve appropriate antibiotic prescribing.
authors.affiliation: a Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines , Jr. VA Hospital , Hines , Illinois , USA.|b Department of Medicine, Division of Infectious Diseases , Loyola University Stritch School of Medicine , Maywood , Illinois , USA.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Fitzpatrick
authors.affiliation: a Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines , Jr. VA Hospital , Hines , Illinois , USA.|c Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy , University of Illinois at Chicago , Chicago , Illinois , USA.
authors.forename: Katie J
authors.initials: KJ
authors.lastname: Suda
authors.affiliation: d Department of Veterans Affairs, William S. Middleton VA Medical Center , Madison , Wisconsin , USA.|e Department of Medicine, Division of Infectious Diseases , University of Wisconsin , Madison , Wisconsin , USA.
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
authors.affiliation: f Department of Veterans Affairs, VA Puget Sound Healthcare System , Seattle , Washington , USA.|g Department of Rehabilitation Medicine , University of Washington , Seattle , Washington , USA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Burns
authors.affiliation: h Department of Veterans Affairs , VA Salt Lake City Healthcare System , Salt Lake City , Utah , USA.|i Department of Medicine, Division of Epidemiology , University of Utah , Salt Lake City , Utah , USA.
authors.forename: Makoto M
authors.initials: MM
authors.lastname: Jones
authors.affiliation: a Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines , Jr. VA Hospital , Hines , Illinois , USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Poggensee
authors.affiliation: a Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines , Jr. VA Hospital , Hines , Illinois , USA.
authors.forename: Swetha
authors.initials: S
authors.lastname: Ramanathan
authors.affiliation: a Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines , Jr. VA Hospital , Hines , Illinois , USA.|j Center for Healthcare Studies and Department of Preventive Medicine Institute for Public Health and Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA.
authors.forename: Charlesnika T
authors.initials: CT
authors.lastname: Evans
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bacterial; Drug resistance; Epidemiology; Gram-negative bacteria; Gram-positive bacteria; Spinal cord injury