Article

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 1 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.

Langue : ANGLAIS