Blue Ribbon Abstract Award: Long-Term Outcomes from Nosocomial Infections in Persons with Spinal Cord Injuries and Disorders

Blue Ribbon Abstract Award: Long-Term Outcomes from Nosocomial Infections in Persons with Spinal Cord Injuries and Disorders Pages E21-E22 S.L. LaVela, C.T. Evans, S. Miskevics, P. Mike, P.P. Jorge Close Close preview | Purchase PDF (63 K) | Related articles | Related reference work articles AbstractAbstract BACKGROUND/OBJECTIVES: In persons with spinal cord injuries and disorders (SCI&D), infection is the most common reason for rehospitalization, emergency room visits, and death. The long-term consequences of infection may also contribute to increased health care utilization and/or death. The objective was to assess long-term outcomes associated with previous nosocomial infections in individuals with SCI&D. METHODS: Cohort study of individuals with SCI&D who had at least one hospital admission during fiscal year 2002 (FY02) (10/01–9/02). Starting from the first FY02 admission each patient was followed for 3 years to assess long-term outcomes (inpatient (IP) days, outpatient (OP) visits, and mortality). Chi-square, t-tests, and survival analysis were used to assess differences between individuals who had at least one nosocomial infection during FY02 and those with none in terms of demographic, injury, and health characteristics, and outcomes. Multivariate logistic regression was used to assess the relationship of prior infection with long term mortality. RESULTS: 115 people had at least one infection (n = 226). Groups did not differ by gender, ethnicity, or marital status. Those missing duration, level, and age at injury values were more likely to be in the non-infection group. Individuals with SCI&D who had at least one past occurrence of a nosocomial infection were older (60 vs. 56 years, p = 0.04) and had more comorbidities (mean: 1.19 vs. 0.70, p = 0.01). During the 3 year follow-up, they had more mean IP admissions (4.66 vs. 3.13, p < 0.0001) and a longer average length of stay (LOS) for IP admissions (196.02 vs. 79.04, p < 0.0001) and longer average extended care LOS (45.68 vs. 12.52, p = 0.045) than those with no infections. There were no differences in the mean number of extended care days or number of OP visits. During follow-up, 14% (n = 16) of people without infections died compared with 29% (n = 32) who had experienced at least one infection, p = 0.0006. Individuals with no infections lived longer than those who experienced nosocomial infection(s) (mean survival time = 1006 vs. 921 days, p < 0.006). Multivariate regression indicated that having had a past infection (OR = 2.34, 95% CI 1.05-5.23, p=0.04) was significantly associated with long term mortality after controlling for confounders. CONCLUSIONS: Nosocomial infections are associated with more IP hospital use, longer admissions, a higher risk of death, and shorter survival time in persons with SCI&D followed for 3 years. OP utilization did not differ, suggesting that nosocomial infections have more serious consequences that result in hospitalization and death. Efforts to reduce long-term adverse effects should focus on prevention of nosocomial infections.