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

Evans CT, Burns SP, Chin A, Weaver FM, Hershow RC. Predictors and outcomes of antibiotic adequacy for bloodstream infections in veterans with spinal cord injury. Arch Phys Med Rehabil 2009;90:1364-70. Objective: To identify predictors and outcomes associated with receiving inadequate empirical antimicrobial treatment for bloodstream infections (BSIs) in persons with spinal cord injury (SCI). Design: Retrospective cohort study from October 1, 1997, through September 30, 2004. Setting: A Department of Veterans Affairs SCI center that serves approximately 700 patients a year. Participants: Hospitalized patients with SCI (N=123) who had I or more BSIs during the study period. Interventions: Not applicable. Main Outcome Measures: Adequacy of antimicrobial treatment (inadequate treatment was defined as the absence of antimicrobial agents for a particular organism within 2 days after the collection of blood cultures and/or the microorganism's resistance to the antimicrobial administered), hospital length of stay (LOS) post-BSI infection, and in-hospital and 30-day mortality. Cluster-adjusted multivariable models were assessed. Results: Over one third (88; 37.4%) of the 235 episodes of BSI identified received inadequate empirical antibiotic treatment. Having a polymicrobial BSI was associated with inadequate treatment (odds ratio [OR]=3.28; 95% confidence interval [CI] = 1.62-6.65; P=.001). Factors protective against inadequate therapy included having a comorbid pressure ulcer (OR=0.37; 95% CI=0.21-0.68; P=.001) or a BSI that was not primary (OR=0.30; 95% CI=0.15-0.58; P < 0001). Mortality did not differ between the inadequate and adequate treatment groups (11.4% vs 10.9%; P=.92). Similarly LOS postinfection was not affected by treatment status (inadequate treatment median=22d vs adequate treatment median=27d; P=.98). Conclusions: Over one third of patients received inadequate empirical treatment, which was associated with having a polymicrobial BSI. However, inadequate treatment was not associated with increased mortality or LOS postinfection.