• Charlesnika T Evans, Stephen P Burns, Amy Chin, Frances M Weaver, and Ronald C Hershow.
• Department of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Center for Management of Complex Chronic Care, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL 60141, USA. Charlesnika.Evans@va.gov
• Arch Phys Med Rehabil. 2009 Aug 1; 90 (8): 1364-70.

ObjectiveTo identify predictors and outcomes associated with receiving inadequate empirical antimicrobial treatment for bloodstream infections (BSIs) in persons with spinal cord injury (SCI).DesignRetrospective cohort study from October 1, 1997, through September 30, 2004.SettingA Department of Veterans Affairs SCI center that serves approximately 700 patients a year.ParticipantsHospitalized patients with SCI (N=123) who had 1 or more BSIs during the study period.InterventionsNot applicable.Main Outcome MeasuresAdequacy 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.ResultsOver 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).ConclusionsOver 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.

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