Prospective surveillance for antibiotic-resistant organisms in patients with spinal cord injury admitted to an acute rehabilitation unit

Background: The objective of this study was to evaluate the epidemiology of antibiotic-resistant organisms among patients with spinal cord injury admi tted to an acute rehabilitation unit for the first time. Methods: After informed consent, 63 patients with spinal cord injury admitt ed to an acute rehabilitation unit between January 1997 and July 1998 had s urveillance cultures (nares, urine, wounds or ulcers, and perineum) done on admission and every 2 weeks thereafter until discharge or as long as 6 wee ks after admission. Results: Of the 4 surveillance sites, perineal cultures most commonly grew one or more potential pathogens; however, antibiotic-resistant organisms we re most often isolated fi om wounds or ulcers and least often in urine cult ures. Staphylococcus aureus (methicillin-sensitive plus methicillin-resista nt) and enterococci represented 44% of all organisms isolated in surveillan ce cultures. Methicillin-resistant S aureus was the most common resistant o rganism isolated. Less than 30% of the gram-negative bacilli isolated were considered antibiotic-resistant strains. Nosocomial infection as a result o f any resistant organism was infrequent. After adjusting for various confou nding factors in a logistic regression model, only the presence of a pressu re ulcer predicted carriage of any resistant organism on admission to the r ehabilitation unit. Acquisition of a resistant organism after admission to the unit at one or more surveillance sites occurred in 8 (22%) of 36 patien ts not colonized on admission. Conclusions: Methicillin-resistant S aureus was the most common resistant o rganism colonizing patients with spinal cord injury at the time of admissio n to an acute rehabilitation unit and throughout their stay. However, acqui sition of any resistant organism after admission was uncommon on this unit, which used Standard Precautions in the routine care of patients. These fin dings have implications for the type of isolation procedures on acute rehab ilitation units. The low rate of acquisition and infection with MRSA after admission argues against attempts at eradication as a method of control.