Changes in bacterial epidemiology and antibiotic resistance among veterans with spinal cord injury/disorder over the past 9 years

The Journal of Spinal Cord Medicine, 2018 · DOI: 10.1080/10790268.2017.1281373 · Published: January 1, 2018

Simple Explanation

This study looked at how common different types of bacteria are in veterans with spinal cord injuries and disorders (SCI/D). It also examined how resistant these bacteria are to antibiotics over a 9-year period. The researchers found that Gram-negative bacteria (GNB) are becoming more common in this population, and many of these bacteria are resistant to multiple antibiotics. Specifically, resistance to fluoroquinolones is increasing. These findings highlight the need for careful antibiotic use and infection control measures to prevent the spread of resistant bacteria in veterans with SCI/D.

Study Duration

9 Years

Participants

19,421 Veterans with SCI/D

Evidence Level

Retrospective cohort

Key Findings

1
The proportion of Gram-negative bacteria (GNB) isolates increased over time in Veterans with SCI/D.
2
Vancomycin resistance in Enterococcus faecalis and E. faecium increased significantly during the study period.
3
Multidrug resistance and fluoroquinolone resistance in Gram-negative bacteria also increased over the study period.

Research Summary

This retrospective cohort study analyzed data from 19,421 Veterans with SCI/D across 130 VAMCs between 2005 and 2013 to assess trends in bacterial epidemiology and antibiotic resistance. The study found an increasing proportion of Gram-negative bacteria (GNB) isolates, rising vancomycin resistance in Enterococcus, and increased multidrug and fluoroquinolone resistance in GNB. The authors conclude that targeted antimicrobial stewardship interventions are needed to encourage judicious antibiotic use and inform the development of empirical antibiotic treatment guidelines for the SCI/D population.

Practical Implications

Improve Empirical Antibiotic Prescribing

Knowledge of local and regional epidemiologic trends in antibiotic resistance in patients with SCI/D may improve appropriate antibiotic prescribing.

Targeted Antimicrobial Stewardship

Implement targeted antimicrobial stewardship interventions to encourage judicious antibiotic use in patients with SCI/D, particularly for agents such as FQ antibiotics.

Inform Infection Control Practices

Understanding the changing bacterial epidemiology can inform best practices for infection prevention, MDRO surveillance, and antibiotic guidelines for medical centers with large SCI/D populations.

Study Limitations

1
Findings may have limited generalizability due to the predominantly male population studied.
2
Retrospective study design and use of administrative datasets limited collection of patient-level clinical data and risk factors.
3
Exclusion of cultures without antibiotic susceptibility testing may have excluded some clinically relevant isolates.

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