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Unique Risks and Clinical Outcomes Associated With Extended-Spectrum β-Lactamase Enterobacteriaceae in Veterans With Spinal Cord Injury or Disorder: A Case-Case-Control Study

Published online by Cambridge University Press:  30 March 2016

Margaret A. Fitzpatrick ,
Katie J. Suda ,
Nasia Safdar ,
Barry Goldstein ,
Makoto M. Jones ,
Linda Poggensee ,
Swetha Ramanathan ,
Ryan LeWan  and
Charlesnika T. Evans
Margaret A. Fitzpatrick*
Affiliation:
Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare and Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines, Jr. VA Hospital, Hines, Illinois Department of Medicine, Division of Infectious Diseases, Loyola University Stritch School of Medicine, Maywood, Illinois
Katie J. Suda
Affiliation:
Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare and Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines, Jr. VA Hospital, Hines, Illinois Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
Nasia Safdar
Affiliation:
Department of Veterans’ Affairs, William S. Middleton VA Medical Center, Madison, Wisconsin Department of Medicine, Division of Infectious Diseases, University of Wisconsin, Madison, Wisconsin
Barry Goldstein
Affiliation:
Department of Veterans’ Affairs, Office of Spinal Cord Injury and Disorders Services, VA Puget Sound Healthcare System, Seattle, Washington Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
Makoto M. Jones
Affiliation:
Department of Veterans’ Affairs, VA Salt Lake City Healthcare System, Salt Lake City, Utah Department of Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah
Linda Poggensee
Affiliation:
Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare and Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines, Jr. VA Hospital, Hines, Illinois
Swetha Ramanathan
Affiliation:
Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare and Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines, Jr. VA Hospital, Hines, Illinois Department of Veterans’ Affairs, Department of Pharmacy, Edward Hines, Jr., VA Hospital, Hines, Illinois
Ryan LeWan
Affiliation:
Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare and Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines, Jr. VA Hospital, Hines, Illinois
Charlesnika T. Evans
Affiliation:
Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare and Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines, Jr. VA Hospital, Hines, Illinois Center for Healthcare Studies and Department of Preventive Medicine Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
*
Address correspondence to Margaret A. Fitzpatrick, MD, MS, 5000 S. 5th Ave., Hines, IL 60141 ([email protected]).
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Abstract

OBJECTIVES

To describe the burden of extended-spectrum β-lactamase (ESBL) Enterobacteriaceae in veterans with spinal cord injury or disorder (SCI/D), to identify risk factors for ESBL acquisition, and to assess impact on clinical outcomes

DESIGN

Retrospective case-case-control study

PATIENTS AND SETTING

Veterans with SCI/D and utilization at a Veterans’ Affairs medical center from January 1, 2012, to December 31, 2013.

METHODS

Patients with a positive culture for ESBL Klebsiella pneumoniae, Escherichia coli, or Proteus mirabilis were matched with patients with non-ESBL organisms by organism, facility, and level of care and to uninfected controls by facility and level of care. Inpatients were also matched by time at risk. Univariate and multivariate matched models were assessed for differences in risk factors and outcomes.

RESULTS

A total of 492 cases (62.6% outpatients) were matched 1:1 with each comparison group. Recent prior use of fluoroquinolones and prior use of third- and fourth-generation cephalosporins were independently associated with ESBL compared to the non-ESBL group (adjusted odds ratio [aOR], 2.61; 95% confidence interval [CI], 1.77–3.84; P<.001 for fluoroquinolones and aOR, 3.86; 95% CI, 2.06–7.25; P<.001 for third- and fourth-generation cephalosporins) and the control group (aOR, 2.10; 95% CI, 1.29–3.43; P = .003 for fluoroquinolones; and aOR, 3.31; 95% CI, 1.56–7.06; P=.002 for third- and fourth-generation cephalosporins). Although there were no differences in mortality rate, the ESBL group had a longer post-culture length of stay (LOS) than the non-ESBL group (incidence rate ratio, 1.36; 95% CI, 1.13–1.63; P=.001).

CONCLUSIONS

All SCI/D patients with ESBL were more likely to have had recent exposure to fluoroquinolones or third- and fourth-generation cephalosporins, and hospitalized patients were more likely to have increased post-culture LOS. Programs targeted toward reduced antibiotic use in SCI/D patients may prevent subsequent ESBL acquisition.

Infect Control Hosp Epidemiol 2016;37:768–776

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 7 , July 2016 , pp. 768 - 776
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Sader, HS, Farrell, DJ, Flamm, RK, Jones, RN. Antimicrobial susceptibility of Gram-negative organisms isolated from patients hospitalized in intensive care units in United States and European hospitals (2009–2011). Diagn Microbiol Infect Dis 2014;78:443–448.Google Scholar
2. Ben-Ami, R, Rodriguez-Bano, J, Arslan, H, et al. A multinational survey of risk factors for infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae in nonhospitalized patients. Clin Infect Dis 2009;49:682–690.Google Scholar
3. Sievert, DM, Ricks, P, Edwards, JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infect Control Hosp Epidemiol 2013;34:1–14.CrossRefGoogle Scholar
4. Kallen, AJ, Hidron, AI, Patel, J, Srinivasan, A. Multidrug resistance among Gram-negative pathogens that caused healthcare-associated infections reported to the National Healthcare Safety Network, 2006–2008. Infect Control Hosp Epidemiol 2010;31:528–531.Google Scholar
5. Lee, SY, Kotapati, S, Kuti, JL, Nightingale, CH, Nicolau, DP. Impact of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species on clinical outcomes and hospital costs: a matched cohort study. Infect Control Hosp Epidemiol 2006;27:1226–1232.CrossRefGoogle ScholarPubMed
6. Schwaber, MJ, Carmeli, Y. Mortality and delay in effective therapy associated with extended-spectrum beta-lactamase production in Enterobacteriaceae bacteraemia: a systematic review and meta-analysis. J Antimicrob Chemother 2007;60:913–920.Google Scholar
7. Evans, CT, LaVela, SL, Weaver, FM, et al. Epidemiology of hospital-acquired infections in Veterans with spinal cord injury and disorder. Infect Control Hosp Epidemiol 2008;29:234–242.CrossRefGoogle ScholarPubMed
8. Annual statistical report – complete public version. National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham website. https://http://www.nscisc.uab.edu/PublicDocuments/reports/pdf/2014 NSCISC Annual Statistical Report Complete Public Version.pdf. Published 2014. Accessed September 24, 2015.Google Scholar
9. Nicolle, LE, Buffet, L, Alfieri, N, Tate, R. Nosocomial infections on a rehabilitation unit in an acute care hospital. Infect Control Hosp Epidemiol 1988;9:553–558.CrossRefGoogle Scholar
10. Mylotte, JM, Graham, R, Kahler, L, Young, BL, Goodnough, S. Impact of nosocomial infection on length of stay and functional improvement among patients admitted to an acute rehabilitation unit. Infect Control Hosp Epidemiol 2001;22:83–87.Google Scholar
11. LaVela, SL, Evans, CT, Miskevics, S, Parada, JP, Priebe, M, Weaver, FM. Long-term outcomes from nosocomial infections in persons with spinal cord injuries and disorders. Am J Infect Control 2007;35:393–400.Google Scholar
12. Lim, CJ, Cheng, AC, Kennon, J, et al. Prevalence of multidrug-resistant organisms and risk factors for carriage in long-term care facilities: a nested case-control study. J Antimicrob Chemother 2014;69:1972–1980.Google Scholar
13. Ludden, C, Cormican, M, Vellinga, A, Johnson, JR, Austin, B, Morris, D. Colonisation with ESBL-producing and carbapenemase-producing Enterobacteriaceae, vancomycin-resistant enterococci, and meticillin-resistant Staphylococcus aureus in a long-term care facility over one year. BMC Infect Dis 2015;15:168.Google Scholar
14. LaVela, SL, Smith, B, Weaver, FM, Miskevics, SA. Geographical proximity and health care utilization in veterans with SCI&D in the USA. Soc Sci Med 2004;59:2387–2399.CrossRefGoogle ScholarPubMed
15. Mylotte, JM, Kahler, L, Graham, R, Young, L, Goodnough, S. Prospective surveillance for antibiotic-resistant organisms in patients with spinal cord injury admitted to an acute rehabilitation unit. Am J Infect Control 2000;28:291–297.Google Scholar
16. Yoon, SB, Lee, BS, Lee, KD, Hwang, SI, Lee, HJ, Han, ZA. Comparison of bacterial strains and antibiotic susceptibilities in urinary isolates of spinal cord injury patients from the community and hospital. Spinal Cord 2014;52:298–301.CrossRefGoogle ScholarPubMed
17. Slim, E, Smit, CA, Bos, AJ, Peerbooms, PG. Nosocomial transmission of highly resistant microorganisms on a spinal cord rehabilitation ward. J Spinal Cord Med 2009;32:422–427.CrossRefGoogle ScholarPubMed
18. Smith, BM, Evans, CT, Ullrich, P, et al. Using VA data for research in persons with spinal cord injuries and disorders: Lessons from SCI QUERI. J Rehabil Res Dev 2010;47:679–688.CrossRefGoogle ScholarPubMed
19. Vasoo, S, Barreto, JN, Tosh, PK. Emerging issues in Gram-negative bacterial resistance: An update for the practicing clinician. Mayo Clin Proc 2015;90:395–403.Google Scholar
20. Hawser, SP, Badal, RE, Bouchillon, SK, et al. Susceptibility of Gram-negative aerobic bacilli from intra-abdominal pathogens to antimicrobial agents collected in the United States during 2011. J Infect 2014;68:71–76.Google Scholar
21. Waites, KB, Chen, Y, DeVivo, MJ, Canupp, KC, Moser, SA. Antimicrobial resistance in Gram-negative bacteria isolated from the urinary tract in community-residing persons with spinal cord injury. Arch Phys Med Rehabil 2000;81:764–769.Google Scholar
22. Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987;40:373–383.Google Scholar
23. Safdar, N, Maki, DG. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, Enterococcus, Gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med 2002;136:834–844.Google Scholar
24. VA research on spinal cord injury. U.S. Department of Veterans’ Affairs, Office of Research and Development website. http://www.research.va.gov/pubs/docs/va_factsheets/sci.pdf. Published 2015. Accessed August 12, 2015.Google Scholar
25. Martins, CF, Bronzatto, E, Neto, JM, Magalhaes, GS, D’Anconna, CA, Cliquet, A Jr. Urinary tract infection analysis in a spinal cord injured population undergoing rehabilitation--how to treat? Spinal Cord 2013;51:193–195.CrossRefGoogle Scholar
26. Girard, R, Mazoyer, MA, Plauchu, MM, Rode, G. High prevalence of nosocomial infections in rehabilitation units accounted for by urinary tract infections in patients with spinal cord injury. J Hosp Infect 2006;62:473–479.Google Scholar
27. Cremet, L, Bemer, P, Rome, J, et al. Outbreak caused by Proteus mirabilis isolates producing weakly expressed tem-derived extended-spectrum beta-lactamase in spinal cord injury patients with recurrent bacteriuria. Scand J Infect Dis 2011;43:957–961.Google Scholar
28. Chopra, T, Marchaim, D, Johnson, PC, et al. Risk factors for bloodstream infection caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: A focus on antimicrobials including cefepime. Am J Infect Control 2015;43:719–723.Google Scholar
29. Rodriguez-Bano, J, Picon, E, Gijon, P, et al. Community-onset bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli: Risk factors and prognosis. Clin Infect Dis 2010;50:40–48.Google Scholar
30. Marchaim, D, Chopra, T, Bhargava, A, et al. Recent exposure to antimicrobials and carbapenem-resistant Enterobacteriaceae: The role of antimicrobial stewardship. Infect Control Hosp Epidemiol 2012;33:817–830.Google Scholar
31. Denis, B, Lafaurie, M, Donay, JL, et al. Prevalence, risk factors, and impact on clinical outcome of extended-spectrum beta-lactamase-producing Escherichia coli bacteraemia: a five-year study. Int J Infect Dis 2015;39:1–6.Google Scholar
32. Van Aken, S, Lund, N, Ahl, J, Odenholt, I, Tham, J. Risk factors, outcome and impact of empirical antimicrobial treatment in extended-spectrum beta-lactamase-producing Escherichia coli bacteraemia. Scand J Infect Dis 2014;46:753–762.Google Scholar
33. Evans, CT, Rogers, TJ, Chin, A, et al. Antibiotic prescribing trends in the emergency department for Veterans with spinal cord injury and disorder 2002–2007. J Spinal Cord Med 2013;36:492–498.Google Scholar
34. Nicolle, LE, Bradley, S, Colgan, R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40:643–654.Google Scholar
35. Waites, KB, Canupp, KC, Brookings, ES, DeVivo, MJ. Effect of oral ciprofloxacin on bacterial flora of perineum, urethra, and lower urinary tract in men with spinal cord injury. J Spinal Cord Med 1999;22:192–198.Google Scholar
36. Barber, C, Lacaille, D, Fortin, PR. Systematic review of validation studies of the use of administrative data to identify serious infections. Arthritis Care Res (Hoboken) 2013;65:1343–1357.Google Scholar
37. Drahos, J, Vanwormer, JJ, Greenlee, RT, Landgren, O, Koshiol, J. Accuracy of ICD-9-CM codes in identifying infections of pneumonia and herpes simplex virus in administrative data. Ann Epidemiol 2013;23:291–293.Google Scholar