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NHSN Annual Update:
Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections

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Antimicrobial-resistant pathogens that cause healthcare-associated infections (HAIs) pose an ongoing and increasing challenge to hospitals, both in the clinical treatment of patients and in the prevention of the cross-transmission of these problematic pathogens.  Describing the magnitude of the problem with respect to these antimicrobial-resistant pathogens is challenging, because the levels of antimicrobial resistance vary for different types of healthcare facilities and for different geographic areas, and some resistance phenotypes are difficult for laboratories to detect. However, the findings from such attempts may help the infection control and public health communities target problems and utilize resources more efficiently.

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March 2008

Volume 29, Number 3
Infect Control Hosp Epidemiol 2008;29:234–242
© 2008 by The Society for Healthcare Epidemiology of America. All rights reserved.
0899-823X/2008/2903-0006$15.00
DOI: 10.1086/527509
Original Article

Epidemiology of Hospital‐Acquired Infections in Veterans With Spinal Cord Injury and Disorder

Charlesnika T. Evans, PhD, MPH;

Sherri L. LaVela, MPH, MBA;

Frances M. Weaver, PhD;

Michael Priebe, MD;

Paul Sandford, MD;

Pamela Niemiec, RN, CIC, MPH;

Scott Miskevics, BS;

Jorge P. Parada, MD, MPH

From the Department of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Center for Management of Complex Chronic Care (C.T.E., S.L.L., F.M.W., S.M., J.P.P.), and the Infection Control Section (P.N.), Edward Hines Jr. Veterans Affairs Hospital, Hines; the Center for Research on Health and Aging, University of Illinois at Chicago (S.L.L.), the Department of Neurology and Institute for Health Services and Policy Research, Northwestern University (F.M.W.), Chicago; Loyola University Chicago, Stritch School of Medicine, Maywood, (J.P.P.), Illinois; Mayo Clinic, Rochester, Minnesota (M.P.); and the Department of Physical Medicine and Rehabilitation, Clement J. Zablocki Veterans Affairs Medical Center, Medical College of Wisconsin, Milwaukee (P.S.).

Objective.To describe the epidemiology of hospital‐acquired infections (HAIs) in veterans with spinal cord injury and disorder (SCI&D).

Design.Retrospective medical record review.

Setting.Midwestern Department of Veterans Affairs spinal cord injury center.

Participants.A total of 226 patients with SCI&D hospitalized at least once during a 2‐year period (October 1, 2001, through September 30, 2003).

Results.A total of 549 hospitalizations were included in the analysis (mean duration of hospitalization, 33.7 days); an HAI occurred during 182 (33.2%) of these hospitalizations. A total of 657 HAIs occurred during 18,517 patient‐days in the hospital (incidence rate, 35.5 HAIs per 1,000 patient‐days). Almost half of the 226 patients had at least 1 HAI; the mean number of HAIs among these patients was 6.0 HAIs per patient. The most common HAIs were urinary tract infection (164 [25.0%] of the 657 HAIs; incidence rate, 8.9 cases per 1,000 patient‐days), bloodstream infection (111 [16.9%]; incidence rate, 6.0 cases per 1,000 patient‐days), and bone and joint infection (103 [15.7%]; incidence rate, 5.6 cases per 1,000 patient‐days). The most common culture isolates were gram‐positive bacteria (1,082 [45.6%] of 2,307 isolates), including Staphylococcus aureus, and gram‐negative bacteria (1,033 [43.6%] of isolates), including Pseudomonas aeruginosa. Multivariable regression demonstrated that predictors of HAI were longer length of hospital stay (P = .002), community‐acquired infection (P = .007), and use of a urinary invasive device (P = .01) or respiratory invasive device (P = .04).

Conclusions.The overall incidence of HAIs in persons with SCI&D was higher than that reported for other populations, confirming the increased risk of HAI in persons with spinal cord injury. The increased risk associated with longer length of stay and with community‐acquired infection suggests that strategies are needed to reduce the duration of hospitalization and to effectively treat community‐acquired infection, to decrease infection rates. There is significant room for improvement in reducing the incidence of HAIs in this population.

Received July 27, 2007; accepted October 24, 2007; electronically published February 4, 2008.

Address reprint requests to Charlesnika T. Evans, PhD, MPH, Edward J. Hines Jr. Veterans Affairs Hospital (151H), Fifth Avenue and Roosevelt Road, P.O. Box 5000, Room D302, Hines, IL 60141 ().

Cited by

C T Evans, R C Hershow, A Chin, P R Foulis, S P Burns, F M Weaver. (2009) Bloodstream infections and setting of onset in persons with spinal cord injury and disorder. Spinal Cord
Online publication date: 24-Mar-2009.
CrossRef

  • Presented in part: 16th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; Chicago, Illinois; March 18‐21, 2006 (abstract 211).

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