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Healthcare facility-onset, healthcare facility-associated infection in Veterans with spinal cord injury and disorder.
Evans CT, Fitzpatrick M, Ramanathan S, Kralovic SM, Burns SP, Goldstein B, Smith B, Gerding DN, Johnson S. Healthcare facility-onset, healthcare facility-associated infection in Veterans with spinal cord injury and disorder. The journal of spinal cord medicine. 2020 Sep 1; 43(5):642-652.
To describe the burden and risk of healthcare facility-onset, healthcare facility-associated (HO-HCFA) infection (CDI) in Veterans with spinal cord injury and disorder (SCI/D). Retrospective, longitudinal cohort study from October 1, 2001-September 30, 2010. Ninety-four acute care Veterans Affairs facilities. Patients with SCI/D. Incidence rate of HO-HCFA CDI. Rates of CDI were determined, and crude unadjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated. Multivariable Poisson random-effects regression analyses were used to assess factors independently associated with the rate of CDI. 1,409 cases of HO-HCFA CDI were identified. CDI rates in 2002 were 13.9/10,000 person-days and decreased to 5.5/10,000 person-days by 2010. Multivariable regression analyses found that antibiotic (IRR? = 18.79, 95% CI 14.09-25.07) and proton-pump inhibitor (PPI) or H2 blocker use (IRR? = 7.71, 95% CI 5.47-10.86) were both independently associated with HO-HCFA CDI. Exposure to both medications demonstrated a synergistic risk (IRR? = 37.55, 95% CI 28.39-49.67). Older age, Northeast region, and invasive respiratory procedure in the prior 30 days were also independent risk factors, while longer SCI duration and care at a SCI center were protective. Although decreasing, CDI rates in patients with SCI/D remain high. Targeted antimicrobial stewardship and pharmacy interventions that reduce antibiotic and PPI/H2 blocker use could have profound benefits in decreasing HO-HCFA CDI in this high-risk population.