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  • Title: Predictors and outcomes of antibiotic adequacy for bloodstream infections in veterans with spinal cord injury.
    Author: Evans CT, Burns SP, Chin A, Weaver FM, Hershow RC.
    Journal: Arch Phys Med Rehabil; 2009 Aug; 90(8):1364-70. PubMed ID: 19651270.
    Abstract:
    OBJECTIVE: To identify predictors and outcomes associated with receiving inadequate empirical antimicrobial treatment for bloodstream infections (BSIs) in persons with spinal cord injury (SCI). DESIGN: Retrospective cohort study from October 1, 1997, through September 30, 2004. SETTING: A Department of Veterans Affairs SCI center that serves approximately 700 patients a year. PARTICIPANTS: Hospitalized patients with SCI (N=123) who had 1 or more BSIs during the study period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Adequacy of antimicrobial treatment (inadequate treatment was defined as the absence of antimicrobial agents for a particular organism within 2 days after the collection of blood cultures and/or the microorganism's resistance to the antimicrobial administered), hospital length of stay (LOS) post-BSI infection, and in-hospital and 30-day mortality. Cluster-adjusted multivariable models were assessed. RESULTS: Over one third (88; 37.4%) of the 235 episodes of BSI identified received inadequate empirical antibiotic treatment. Having a polymicrobial BSI was associated with inadequate treatment (odds ratio [OR]=3.28; 95% confidence interval [CI]=1.62-6.65; P=.001). Factors protective against inadequate therapy included having a comorbid pressure ulcer (OR=0.37; 95% CI=0.21-0.68; P=.001) or a BSI that was not primary (OR=0.30; 95% CI=0.15-0.58; P<.0001). Mortality did not differ between the inadequate and adequate treatment groups (11.4% vs 10.9%; P=.92). Similarly LOS postinfection was not affected by treatment status (inadequate treatment median=22d vs adequate treatment median=27d; P=.98). CONCLUSIONS: Over one third of patients received inadequate empirical treatment, which was associated with having a polymicrobial BSI. However, inadequate treatment was not associated with increased mortality or LOS postinfection.
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