Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois, USA.
Department of Preventive Medicine and Center for Healthcare Studies, Northwestern University, Chicago, Illinois, USA.
J Spinal Cord Med. 2020 Sep;43(5):642-652. doi: 10.1080/10790268.2019.1672953. Epub 2019 Oct 30.
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.
描述脊髓损伤和疾病（SCI/D）退伍军人在医疗机构发生的（HO-HCFA）感染（CDI）的负担和风险。2001 年 10 月 1 日至 2010 年 9 月 30 日的回顾性、纵向队列研究。94 家急性保健退伍军人事务设施。患有 SCI/D 的患者。HO-HCFA CDI 的发病率。确定了 CDI 的发生率，并计算了未经调整的粗发病率比（IRR）和 95%置信区间（CI）。多变量泊松随机效应回归分析用于评估与 CDI 发生率独立相关的因素。确定了 1409 例 HO-HCFA CDI。2002 年的 CDI 发生率为 13.9/10000 人天，到 2010 年降至 5.5/10000 人天。多变量回归分析发现，抗生素（IRR=18.79，95%CI 14.09-25.07）和质子泵抑制剂（PPI）或 H2 阻滞剂的使用（IRR=7.71，95%CI 5.47-10.86）均与 HO-HCFA CDI 独立相关。两种药物的暴露表现出协同风险（IRR=37.55，95%CI 28.39-49.67）。年龄较大、东北地区以及在过去 30 天内进行的侵入性呼吸程序也是独立的危险因素，而 SCI 持续时间较长和在 SCI 中心接受治疗则具有保护作用。尽管有所下降，但 SCI/D 患者的 CDI 发生率仍然很高。有针对性的抗菌药物管理和药房干预措施，减少抗生素和 PPI/H2 阻滞剂的使用，可以极大地降低这一高危人群的 HO-HCFA CDI 发生率。
