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

描述(由申请人提供)： 感染是医院护理最常见的并发症，也是美国十大主要死亡原因之一。多药耐药革兰氏阴性菌(MDRGNO)每年在医疗保健环境中的感染率稳步上升；包括肺炎、血液感染、伤口或手术部位感染以及脑膜炎。尤其令人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。了解这些感染的负担的重要性通过它们对治疗方案的影响而得到强调；需要更复杂的治疗。此外，这些微生物已被发现与发病率和死亡率增加、住院时间延长和成本增加有关。然而，在脊髓损伤和疾病(SCI/D)患者中，关于抗生素耐药模式及其对预后的影响的文献有限。与普通患者相比，SCI/D患者感染这些疾病的风险较高，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设备，如导尿管，以及发生压疮。此外，感染是SCI/D患者发病和死亡的常见原因。大多数SCI/D退伍军人是慢性损伤；但我们对这一人群中抗生素耐药性的负担、危险因素和影响的数据很少。这项研究的总体目标是描述患病率和危险因素 研究MDRGNO对SCI/D患者造成感染的影响，评估MDRGNO对患者住院结果和长期结果的影响。我们建议使用国家退伍军人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对患者预后的影响。这项拟议的研究还涉及退伍军人康复研究与发展计划的一个优先领域，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，这项研究可以帮助退伍军人管理局MDRO计划办公室和退伍军人管理局SCI/D服务计划办公室未来的努力和优先事项，以了解MDRGNO的负担和结果，并确定是否需要进一步努力遏制由这种细菌引起的感染。

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.