Changes in bacterial epidemiology and antibiotic resistance among veterans with spinal cord injury/disorder over the past 9 years

Fitzpatrick, Margaret A.; Suda, Katie J.; Safdar, Nasia; Burns, Stephen P.; Jones, Makoto; Poggensee, Linda; Ramanathan, Swetha; Evans, Charlesnika T.

doi:10.1080/10790268.2017.1281373

Cited by 33 publications

(29 citation statements)

References 40 publications

(50 reference statements)

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“…[1][2][3]12 Furthermore, asymptomatic bacteriuria is very common in SCI-related NLUTD, and avoidance of overtesting and treating asymptomatic bacteriuria is critical to avoid antibiotic resistance. [1][2][3]10,[21][22][23] Identifying symptomatic UTIs is challenging for most clinicians in the setting of NLUTD. Figure 1 defines significant bacteriuria and outlines an office approach to diagnosis and management of symptomatic UTI.…”

Section: Urinary Tract Infectionmentioning

confidence: 99%

A Primary Care Provider’s Guide to Management of Neurogenic Lower Urinary Tract Dysfunction and Urinary Tract Infection After Spinal Cord Injury

Milligan

Goetz

Kennelly

2020

Topics in Spinal Cord Injury Rehabilitation

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Neurogenic lower urinary tract dysfunction (NLUTD), previously termed neurogenic bladder dysfunction, is a common secondary complication of spinal cord injury (SCI). It is associated with significant morbidity, reduced quality of life, increased health care costs, and mortality. Primary care providers (PCPs) play an important role in optimizing urohealth over the life span. This article will review NLUTD in SCI, its complication, surveillance, and management. PCPs should be aware of SCI-related NLUTD, its complications, management, and surveillance recommendations, and when to refer to a specialist.

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Section: Urinary Tract Infectionmentioning

confidence: 99%

A Primary Care Provider’s Guide to Management of Neurogenic Lower Urinary Tract Dysfunction and Urinary Tract Infection After Spinal Cord Injury

Milligan

Goetz

Kennelly

2020

Topics in Spinal Cord Injury Rehabilitation

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“…Numerous studies have reported that elderly and war veterans often suffer from multiple syndromes with inflammatory phenotypes and are more susceptible to resistance against a large number of antibiotics [16], [17], [18]. Veterans have been reported to be resistant to amoxicillin, β-lactams, fluroquinolones, methicillin and most importantly the carbapenem group of antibiotics [19], [20].…”

Section: Introductionmentioning

confidence: 99%

Gut resistome presents a unique biome signature in chronic multi-symptom illness patients and links persistent pro-inflammatory phenotype in a mouse model reversible by fecal microbiota transfer

Bose¹,

Chatterjee²,

Older³

et al. 2021

Preprint

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Chronic multi-symptom illness (CMI) affects a subsection of elderly and war veterans and is associated with systemic inflammation, chronic fatigue, pain and neuroinflammation. We showed previously that an altered gut microbiome-inflammation axis aids to the symptom reporting and persistence. Here, a mouse model of CMI and a group of Gulf War veterans’ with CMI showed the presence of an altered host resistome, a signature of antibiotic resistance genes within the microbiome. Results showed that antibiotic resistance genes were significantly altered in the CMI group in both mice and GW veterans when compared to the control. Fecal samples from GW veterans with persistent CMI showed a significant increase of resistance to a wide class of antibiotics and exhibited an array of mobile genetic elements distinct than normal healthy controls. Strikingly, the altered resistome and gene signature were correlated with mouse serum IL6 levels. Altered resistome in mice also correlated strongly with intestinal inflammation, decreased synaptic plasticity that was reversible with fecal microbiota transplant (FMT), a tool to restore a healthy biome. The results indicate an emerging linkage of the gut resistome and CMI and might be significant in understanding the risks to treating hospital acquired infections in this population.

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“…3 Overtreatment of ASB promotes the development of multi-drug-resistant organisms, and other complications of antibiotic use such as Clostridioides difficile infection; both of these are common and burdensome in the SCI/D population. [4][5][6][7] Antibiotic stewardship programs, or initiatives aimed to promote the appropriate, safe, and effective use of antibiotics, aim to mitigate these complications, and have been recognized globally as an important public health topic. 8 There are still important knowledge gaps that must be filled before effective antibiotic stewardship programs can be implemented in this patient population.…”

Section: Introductionmentioning

confidence: 99%

“…We have previously described the diagnostic challenge of UTI after SCI/D given the atypical signs and symptoms of infection and the high prevalence of ASB in the population in a narrative review 3. Overtreatment of ASB promotes the development of multi‐drug‐resistant organisms, and other complications of antibiotic use such as Clostridioides difficile infection; both of these are common and burdensome in the SCI/D population 7. Antibiotic stewardship programs, or initiatives aimed to promote the appropriate, safe, and effective use of antibiotics, aim to mitigate these complications, and have been recognized globally as an important public health topic 8…”

Section: Introductionmentioning

confidence: 99%

Spinal Cord Injury Provider Knowledge and Attitudes Toward Bacteriuria Management and Antibiotic Stewardship

Skelton

May

Grigoryan

et al. 2020

PM&R

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Introduction: Bacteriuria, either asymptomatic or urinary tract infection, is common in persons with spinal cord injury or disorder (SCI/D). In the Veterans Health Administration (VHA), conflicting clinical practice guidelines make appropriate bacteriuria management and antibiotic stewardship challenging. Objective: To explore SCI/D provider knowledge, attitudes, and teamwork around bacteriuria management during the VHA SCI/D annual examination. Design: Mixed methods. Setting: VHA SCI/D centers. Participants: SCI/D staff providers and physical medicine and rehabilitation resident physicians. Main Outcome Measurements: Knowledge, safety, and teamwork scores on bacteriuria management using a validated questionnaire. Themes on barriers and facilitators to bacteriuria management during the SCI/D annual exam, and attitudes toward antibiotic stewardship in general. Results: We received 84 responses from 344 distributed surveys, with a response rate of 24%. Thirty percent of all participants endorsed incorrect triggers for obtaining a urine culture (change in urine color, cloudiness, or odor). The type of organism identified on culture drove unnecessary antibiotic use; 57% would treat asymptomatic bacteriuria if caused by extended spectrum betalactamase Escherichia coli. There were no significant differences between the median (interquartile range [IQR]) knowledge score of the staff providers (70.6 [58.8-82.4]) and the resident physicians (64.7 [58.8-82.4]), but the teamwork climate scores (P = .02) and safety climate scores (P < .01) were higher among staff providers than among resident physicians. Interview analysis identified how the limited recall of content among SCI/D providers of the guidelines for bacteriuria was a potential barrier to their use but attitudes toward guidelines and antibiotic stewardship initiatives were positive. Conclusion: All participants objectively demonstrated actionable gaps in bacteriuria management and expressed uncertainty in their knowledge during qualitative interviews. Through addressing these gaps, we can develop effective antibiotic stewardship programs for the VHA SCI/D system of care.

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Changes in bacterial epidemiology and antibiotic resistance among veterans with spinal cord injury/disorder over the past 9 years

Cited by 33 publications

References 40 publications

A Primary Care Provider’s Guide to Management of Neurogenic Lower Urinary Tract Dysfunction and Urinary Tract Infection After Spinal Cord Injury

A Primary Care Provider’s Guide to Management of Neurogenic Lower Urinary Tract Dysfunction and Urinary Tract Infection After Spinal Cord Injury

Gut resistome presents a unique biome signature in chronic multi-symptom illness patients and links persistent pro-inflammatory phenotype in a mouse model reversible by fecal microbiota transfer

Spinal Cord Injury Provider Knowledge and Attitudes Toward Bacteriuria Management and Antibiotic Stewardship

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