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Multidrug-resistant bacteria in urine culture among patients with spinal cord injury and disorder: Time to first detection and analysis of risk factors

Abstract

Study design

Retrospective cohort study.

Objectives

The aim of this study was to assess the time to first detection of multidrug-resistant bacteria (MDRB) in urine culture and identify risk factors associated with the first detection of MDRB (1st MDRB).

Setting

Spinal Care Ward and Department of Microbiology, Regional Hospital Liberec a.s., Liberec, Czech Republic.

Method

We cultured urine samples from patients in the acute phase of spinal cord injury or disorder (SCI/D). Multidrug resistance (MDR) was defined as acquired nonsusceptibility to at least one agent from three or more antimicrobial categories. Multivariate logistic regression was used to assess the association of bladder management, broad-spectrum antibiotic exposure, mechanical ventilation, pressure ulcers, positive urine culture on admission, and other risk factors with 1st MDRB. We used only the first urine culture with MDRB for evaluation.

Results

A total of 655 urine cultures from 246 individuals were evaluated, and 829 isolates were obtained. The MDRB prevalence among all isolates was 40.2%. MDRB was detected in 146 (59.3%) patients for the first time, and 76.0% of these isolates were from patients with asymptomatic bacteriuria. The median time to 1st MDRB was 37 days (95% CI, 33–41). According to multivariate logistic regression, 1st MDRB was associated with bladder management with urethral or suprapubic catheterization (OR: 2.8, 95% CI, 1.1–7.2).

Conclusion

The prevalence of infections caused by MDRB was high among the SCI/D population, with three-quarters from patients with asymptomatic bacteriuria. Bladder management with an indwelling catheter is associated with an increased risk of 1st MDRB.

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Fig. 1: Kaplan–Meier plots of 1st MDRB.

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank Hana Kolářová, Ph.D. for assistance with data processing and statistical evaluation.

Funding

This work was supported by funding from the Scientific Board of Krajská nemocnice Liberec, a.s.

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Authors and Affiliations

Authors

Contributions

Study concept and design: VŠ, VP. Data analysis and interpretation: VŠ, HK. Microbiology expertise: DF. Manuscript preparation: VŠ, VP. Manuscript review: VŠ, JM. All authors read and approved the final manuscript. All authors consent to the publication of the manuscript in Spinal Cord.

Corresponding author

Correspondence to Vladimír Šámal.

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Competing interests

The authors declare no competing interests.

Ethical approval

This study was approved by the relevant Institutional Review Boards. We certify that all applicable institutional and governmental regulations concerning the ethical use of human subjects data were followed during the course of this research.

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Šámal, V., Paldus, V., Fáčková, D. et al. Multidrug-resistant bacteria in urine culture among patients with spinal cord injury and disorder: Time to first detection and analysis of risk factors. Spinal Cord (2022). https://doi.org/10.1038/s41393-022-00774-1

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