scholarly journals Outcome of bloodstream infections among spinal cord injury patients and impact of multidrug-resistant organisms

Spinal Cord ◽  
2016 ◽  
Vol 55 (2) ◽  
pp. 148-154 ◽  
Author(s):  
M Saliba ◽  
D Saadeh ◽  
F Bouchand ◽  
B Davido ◽  
C Duran ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Cord Injury ◽  
Multidrug Resistant Organisms

scholarly journals Influence of patient isolation due to colonization with multidrug-resistant organisms on functional recovery after spinal cord injury

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0249295
Author(s):  
Peter Prang ◽  
Christian Schuld ◽  
Ruediger Rupp ◽  
Cornelia Hensel ◽  
Norbert Weidner
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Functional Outcome ◽  
Median Duration ◽  
Late Stage ◽  
Multidrug Resistant ◽  
First Year ◽  
Cord Injury ◽  
Multidrug Resistant Organisms ◽  
Duration Of Hospitalization

Study design Chart reviews were combined with neurological and functional outcome data obtained from the prospective European Multicenter Study on Spinal Cord Injury (EMSCI, www.emsci.org). Objectives To determine if strict physical isolation of multidrug-resistant organisms (MDRO)-positive patients negatively affects neurological recovery and functional outcome in the first year after acute spinal cord injury (SCI). Setting SCI Center Heidelberg University Hospital. Methods Individuals with acute (< 6 weeks) traumatic or ischemic SCI were included. During primary comprehensive care, isolated MDRO-positive patients (n = 13) were compared with a MDRO-negative control group (n = 13) matched for functional (Spinal Cord Independence Measure–SCIM) and neurological impairment (motor scores based on the International Standards for Neurological Classification of Spinal Cord Injury—ISNCSCI) at an early stage up to 40 days after SCI. SCIM scores and motor scores were obtained at 12 weeks (intermediate stage) and 24 or 48 weeks (late stage) after SCI. Results Isolated MDRO-positive (median duration of hospitalization: 175 days, 39% of inpatient stay under isolation measures) and non-isolated MDRO-negative (median duration of hospitalization: 161 days) patients showed functional and neurological improvements, which were not statistically different between groups at the intermediate and late stage. Conclusion Prolonged isolation due to MDRO colonization for over a third of the inpatient comprehensive care period does not appear to impair neurological recovery and functional outcome within the first year after SCI.

scholarly journals Reduction of Central-Line–Associated Bloodstream Infections in a Spinal Cord Injury Unit

2020 ◽  
Vol 41 (S1) ◽  
pp. s370-s370
Author(s):  
Stephanie L. Baer ◽  
Amy Halcyon Larsh ◽  
Annalise Prunier ◽  
Victoria Thurmond ◽  
Donna Goins ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Patient Population ◽  
Bloodstream Infections ◽  
Central Line ◽  
Fiscal Year ◽  
Improvement Project ◽  
Central Lines ◽  
Cord Injury ◽  
Bundle Compliance

Background: Central-line–associated bloodstream infections (CLABSIs) are a complication of indwelling central venous catheters, which increase morbidity, mortality, and cost to patients. Objective: Due to increased rates in a spinal cord injury unit (SCIU), a performance improvement project was started to reduce CLABSI in the patient population. Methods: To reduce the incidence of CLABSI, a prevention bundle was adopted, and a peer-surveillance tool was developed to monitor compliance with the bundle. Staff were trained to monitor their peers and submit weekly surveillance. Audits were conducted by the clinical nurse leader with accuracy feedback. Bundle peer-surveillance was implemented in February of 2018 with data being fed back to leadership, peer monitors, and stakeholders. Gaps in compliance were addressed with peer-to-peer education, changes in documentation requirements, and meetings to improve communication and reduce line days. In addition, the use of an antiseptic-impregnated disc for vascular accesses was implemented for dressing changes. Further quality improvement cycles during the first 2 quarters of fiscal year 2019 included service-wide education reinforcement, identification in variance of practice, and reporting to staff and stakeholders. Results: CLABSI bundle compliance increased from 67% to 98% between February and October 2018. The weekly audit reporting accuracy improved from 33% to 100% during the same period. Bundle compliance was sustained through the fourth quarter of 2019 at 98%, and audit accuracy was 99%. The initial CLABSI rates the quarter prior to the intervention were 6.10 infections per 1,000 line days for 1 of the 3 SCIUs and 2.68 infections per 1,000 line days for the service overall. After the action plan was initiated, no CLABSIs occurred for the next 3 quarters in all SCIUs despite unchanged use of central lines (5,726 line days in 2018). The improvement was sustained, and the line days decreased slightly for 2019, with a fiscal year rate of 0.61 per 1,000 line days (ie, 3 CLABSIs in 4,927 central-line days). Conclusions: The incidence of CLABSI in the SCIU was reduced by an intensive surveillance intervention to perform accurate peer monitoring of bundle compliance with weekly feedback, communication, and education strategies, improvement of the documentation, and the use of antiseptic-impregnated discs for dressings. Despite the complexity of the patient population requiring long-term central lines, the CLABSI rate was greatly impacted by evidence-based interventions coupled with reinforcement of adherence to the bundle.Funding: NoneDisclosures: None

Predictors and Outcomes of Antibiotic Adequacy for Bloodstream Infections in Veterans With Spinal Cord Injury

2009 ◽  
Vol 90 (8) ◽  
pp. 1364-1370 ◽  
Author(s):  
Charlesnika T. Evans ◽  
Stephen P. Burns ◽  
Amy Chin ◽  
Frances M. Weaver ◽  
Ronald C. Hershow
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Bloodstream Infections ◽  
Cord Injury

Antibiotic cycling prevents urinary tract infections in spinal cord injury patients and limits the emergence of multidrug resistant organism

2015 ◽  
Vol 71 (4) ◽  
pp. 491-493 ◽  
Author(s):  
Claire Poirier ◽  
Aurélien Dinh ◽  
Jérôme Salomon ◽  
Nathalie Grall ◽  
Antoine Andremont ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Cord Injury ◽  
Antibiotic Cycling ◽  
Tract Infections

scholarly journals Prevalence and Factors Associated With Multidrug-Resistant Gram-Negative Organisms in Patients With Spinal Cord Injury

2017 ◽  
Vol 38 (12) ◽  
pp. 1464-1471 ◽  
Author(s):  
Charlesnika T. Evans ◽  
Margaret A. Fitzpatrick ◽  
Makoto M. Jones ◽  
Stephen P. Burns ◽  
Linda Poggensee ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Geographic Variation ◽  
Healthcare Setting ◽  
Multidrug Resistant ◽  
Electronic Health Record Data ◽  
Gram Negative ◽  
Factors Associated ◽  
Cord Injury ◽  
Gram Negative Organisms

OBJECTIVEInfections caused by multidrug-resistant gram-negative organisms (MDRGNOs) have been increasing every year. The objective of this study was to describe the prevalence of MDRGNOs and factors associated with MDRGNOs in patients with spinal cord injury or disorder (SCI/D).DESIGNRetrospective cohort study.METHODSDepartment of Veterans Affairs (VA) electronic health record data from 142 VA facilities were evaluated for 19,642 patients with SCI/D. Multivariable cluster-adjusted models were fit to identify factors associated with MDRGNO.RESULTSGram-negative (GN) cultures occurred in 44% of patients with SCI/D receiving care at VA facilities, and 11,527 (41.3%) GN cultures had an MDRGNO. The most frequent GN organisms (GNOs) were Escherichia coli (28.5%), Klebsiella pneumoniae (17.0%), and Pseudomonas aeruginosa (16.0%). Two-thirds of GN cultures were from the outpatient setting, where MDRGNO prevalence was 37.6%. Significant geographic variation in the prevalence of MDRGNOs was identified (South, 44.7%; Northeast, 44.3%; West, 36.8%; Midwest, 34.4%). Other factors associated with an MDRGNO were older age, injury characteristics, comorbidities, specimen type, healthcare setting, and healthcare exposure. Black (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.39–1.78) and Hispanic race (OR, 1.58; 95% CI, 1.28–1.95), polymicrobial culture (OR, 2.67; 95% CI, 2.46–2.90), and antibiotic use in the previous 90 days (OR, 1.62; 95% CI, 1.50–1.76) were also associated with having an MDRGNO.CONCLUSIONSMDRGNOs were common in community and healthcare settings among veterans with SCI/D, with significant geographic variation. Health care and antibiotic exposures were significant factors associated with MDRGNOs. Priority should be given to controlling the spread of MDRGNOs in this special population, including a focus on judicious use of antibiotics.Infect Control Hosp Epidemiol 2017;38:1464–1471

scholarly journals Burden and Risk Factors of Multidrug-Resistant Gram-Negative Organisms in Veterans With Spinal Cord Injury

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Charlesnika Evans ◽  
Margaret Fitzpatrick ◽  
Linda Poggensee ◽  
Swetha Ramanathan ◽  
Sherri Lavela ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Multidrug Resistant ◽  
Gram Negative ◽  
Cord Injury ◽  
Gram Negative Organisms
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