Burden and Outcomes of Resistant Gram-negative Organisms in Veterans with SCI/D

描述（由申请人提供）： 感染是医院护理中最常见的并发症，也是美国十大主要死亡原因之一。多重耐药革兰氏阴性菌（MDRGNO）每年在医疗机构中的感染率稳步上升;包括肺炎，血流感染，伤口或手术部位感染和脑膜炎。特别值得关注的是由肺炎克雷伯氏菌、大肠杆菌、铜绿假单胞菌和特别是碳青霉烯耐药肠杆菌科（CRE）引起的感染。了解这些感染对治疗方案的影响强调了了解其负担的重要性;需要更复杂的治疗。此外，已发现这些生物体与发病率和死亡率增加、住院时间延长和费用增加有关。然而，在脊髓损伤和障碍（SCI/D）患者中，文献仅限于抗生素耐药模式及其对结果的影响。与一般患者人群相比，SCI/D患者感染这些感染的风险较高，原因包括频繁住院或与医疗保健系统接触，频繁和长期使用侵入性医疗器械（如导尿管）以及压疮的发展。此外，感染是SCI/D患者发病和死亡的常见原因。大多数SCI/D退伍军人都是慢性损伤;但我们几乎没有关于这一人群的负担，风险因素和抗生素耐药性影响的数据。本研究的总体目标是描述的患病率和危险因素 MDRGNO引起SCI/D患者感染，并评估MDRGNO对患者住院结局和长期结局的影响。我们建议使用国家VA医疗数据集进行回顾性分析，以实现这些目标。此外，我们将进行多项匹配的病例对照研究，以评估MDRGNO对患者结局的影响。拟议的研究还涉及VA康复研究与开发计划的优先领域，因为它认识到慢性SCI/D对随后的并发症和后果（如感染）的影响。此外，这项研究可以帮助VA MDRO项目办公室和VA SCI/D服务项目办公室了解MDRGNO的负担和结果，并确定是否需要进一步努力遏制这种微生物引起的感染。

DESCRIPTION (provided by applicant): Project Summary Infections are the most common complication of hospital care and one of the top 10 leading causes of death in the United States. Multi-drug resistant gram negative organisms (MDRGNOs) account for a steadily increasing rate of infections in healthcare settings every year; including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis. Of particular concern are those infections caused by Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and specifically carbapenem-resistant Enterobacteriaceae (CRE). The importance of understanding the burden of these infections is emphasized by the impact they have on treatment regimens; requiring more complex therapy. In addition, these organisms have been found to be associated with increased morbidity and mortality, longer length of stay, and increased costs. However, in persons with spinal cord injury and disorder (SCI/D), literature is limited on antibiotic resistance patterns and their impacts on outcomes. Persons with SCI/D are at high risk for these infections compared to the general patient population due to factors such as frequent hospitalization or contact with the health care system, frequent and chronic use of invasive medical devices such as urinary catheters, and development of pressure ulcers. Furthermore, infections are a frequent cause of morbidity and mortality in persons with SCI/D. The majority of Veterans with SCI/D are chronically injured; but we have little data on the burden, risk factors, and impact of antibiotic resistance in this population. The overall objectives of this study are to describe the prevalence of and risk factors for MDRGNOs causing infections in persons with SCI/D, and assess impact of MDRGNOs on patient hospitalization outcomes and long-term outcomes. We propose to conduct a retrospective analysis using national VA medical data sets to achieve these aims. Additionally, we will conduct multiple matched case-control studies to assess impact of MDRGNO's on patient outcomes. The proposed study also addresses a priority area of the VA Rehabilitation Research & Development program as it recognizes the impact of chronic SCI/D on subsequent complications and consequences such as infections. In addition, this study can assist with future efforts and priorities of the VA MDRO Program Office and VA SCI/D Services Program Office in understanding the burden of MDRGNO's and outcomes and determine if further efforts are needed to curb infections caused by this organism.