1055 — Bacteria Isolated from Patients with Spinal Cord Injury Versus Other Patients: Is an SCI Unit-Specific Antibiogram Necessary?

Evans CT, VA Center of Innovation for Complex Chronic Healthcare and Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, Hines IL; Patel U, Pharmacy Service, Hines VA Hospital, Hines IL; Sabzwari R, Infectious Diseases, Hines VA Hospital, Hines IL; Spadoni S, Laboratory Service, Hines VA Hospital, Hines IL; Krankoski K, Laboratory Service, Hines VA Hospital, Hines IL; Ramanathan S, VA Center of Innovation for Complex Chronic Healthcare and Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, Hines IL; Hill JN, VA Center of Innovation for Complex Chronic Healthcare and Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, Hines IL; Suda K, VA Center of Innovation for Complex Chronic Healthcare and Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, Hines IL;

Objectives:
Individuals with spinal cord injury or disorder (SCI/D) are at high risk for infections and antimicrobial resistance compared to the general patient population due to factors such as frequent hospitalization and antibiotic use, and frequent and chronic use of invasive devices. Increasing resistance of complex infections can result in inadequate empiric prescribing. Antibiograms (antimicrobial susceptibility reports) are recommended as a tool for selecting adequate empiric antibiotic treatment. However, access to and use of antibiogram, particularly those that are unit specific is limited. The purpose of this project was to evaluate the prevalence and resistance patterns of bacteria isolated from SCI/D patients as compared to non-SCI/D patients and determine whether an SCI/D unit-specific antibiogram is necessary.

Methods:
Microbiology laboratory reports from October 1, 2012-September 30, 2013 for all cultures obtained at a Midwestern Veterans Affairs facility with a large SCI/D unit were evaluated. Only the first isolate cultured from a single patient was included unless the susceptibility pattern changed. Antimicrobial susceptibility results of individual isolates were compiled into a standardized SCI/D unit-specific antibiogram and compared to a compiled facility-wide antibiogram using chi-square tests.

Results:
A total of 5,131 cultures were evaluated; where 1,179 were from SCI/D. Frequencies of pathogens isolated in SCI/D and facility-wide differed; but Escherichia coli was the most frequently cultured bacteria in both groups. In SCI/D, Staphylococcus aureus isolates were less susceptible to oxacillin, (27.8% vs 55.4%, p < 0.0001). Significantly more extended-spectrum beta-lactamase (ESBL) producers (17.6% vs 5.0%; p < 0.0001), carbapenem-resistant Enterobacteriaceae (CRE) (2.4% vs 0.5%; p < 0.0001), carbapenem resistance (7.6% vs 2.4%; p < 0.0001), and isolates resistant to three or more antibiotic classes (60.7% vs 28.0%; p = 0.0001) were seen in SCI/D cultures.

Implications:
Significant differences exist in susceptibilities of microorganisms in patients with SCI/D compared to those without SCI/D. In addition, the frequency of ESBLs in cultures obtained from patients with SCI/D is worrisome.

Impacts:
Antibiograms are recommended as a component of antimicrobial stewardship programs to guide selection of empiric antibiotic treatment. Differences in susceptibilities suggest that developing an SCI/D-unit specific antibiogram may be useful in choosing appropriate empiric treatment. Next steps include implementation of an antibiogram in an SCI/D unit.