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

ABSTRACT

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Our study aimed to describe the outcome of bloodstream infection (BSI) in spinal cord injury (SCI) patients and their associated risk factors for severity and mortality. SETTING: A French University Hospital. METHODS: We conducted a retrospective cohort study of all BSIs occurring in hospitalized SCI patients. We analyzed their outcome and risk factors especially the impact of multidrug-resistant organisms (MDROs). RESULTS: Overall, 318 BSIs occurring among 256 patients were included in the analysis. Mean age was 50.8 years and gender ratio (M/F) was 2.70, with a mean injury duration of 11.6 years.Severity and 30-day mortality of BSI episodes were, respectively, 43.4% and 7.9%. BSI severity was significantly more frequent when caused by respiratory tract infections (RTIs) (odds ratio (OR)=1.38; 95% confidence interval (CI) 1.13-1.44) and significantly lower when caused by urinary tract infections (UTIs) (OR=0.47; 95% CI 0.28-0.76). BSI mortality was significantly higher when caused by RTIs (OR=3.08; 95% CI 1.05-8.99), catheter-related bloodstream infections (OR=3.54; 95% CI 1.36-9.18) or Pseudomonas aeruginosa infections (OR=3.79; 95% CI 1.14-12.55).MDROs were responsible for 41.2% of all BSI. They have no impact on severity and mortality, whichever be the primary site of infection.In multivariate analysis, mortality was higher when BSI episodes were due to RTIs (OR=3.26; 95% CI 1.29-8.22) and Pseudomonas aeruginosa infections (OR=3.53; 95% CI 1.06-11.70), or when associated with immunosuppressive therapy (OR=2.57; 95% CI 1.14-5.78) or initial severity signs (OR=1.68; 95% CI 1.01-2.81). CONCLUSION: BSI occurring in SCI population were often severe but mortality remained low. MDROs were frequent but not associated with severity or mortality of BSI episodes. Risk factors associated with mortality were initial severe presentation, RTI, immunosuppressive therapy and BSI due to Pseudomonas aeruginosa.