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Gunshot injury paraplegics face escalated, costly infectious disease challenges
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Gunshot injury paraplegic patients with spinal cord injuries face escalated infectious disease challenges, including complications from pressure ulcers that can lead to frequent and often costly hospital admissions, physicians said.
“They’re a very vulnerable population. The types of infectious complications they get are just tremendous and horrendous,” Keith S. Kaye, MD, MPH, Infectious Disease News Editorial Board member and professor of internal medicine at the University of Michigan Medical School, said in an interview.
Amid a dramatic rise in the number of cases in the United States, Kaye and colleagues have called for health care reforms to address the need for more incentives for prevention and early intervention of pressure ulcers in these patients.
According to their letter in Infection Control and Hospital Epidemiology, the estimated annual cost in the U.S. of treating pressure ulcers in paraplegics with or without spinal cord injuries is $11 billion, and the cost of healing just one pressure ulcer can reach $40,000. Yet Kaye and colleagues question whether government officials are aware of the issue, or if health care professionals are equipped to deal with it.
They compared the “dramatically different” costs associated with two gunshot injury paraplegic patients with spinal cord injuries who were admitted to a tertiary care hospital in Detroit for treatment of pressure ulcers.
Both patients were black men in their 30s who belonged to low-education and low-income demographic groups, according to Kay and colleagues. Hospital costs for one patient were $46,300 but soared past $262,000 for the other patient because of an infected pressure ulcer that caused him to be readmitted three times and required several diagnostic procedures and surgical interventions like incision and drainage.
“Development of a pressure ulcer in a paraplegic patient can be devastating socially, emotionally, and financially,” Kaye and colleagues wrote. “An American soldier with a [spinal cord injury] is cared for in a very supportive environment. On the other hand, an African-American [gunshot injury paraplegic patient with a spinal cord injury] residing in Detroit with low education, low income and a poor support system has very limited resources to support his physical and mental health. Such destitute patients in the inner city are living slow but irreversible and expensive death sentences.”
Moreover, according to Kaye, patients who are constantly readmitted to the hospital with pressure ulcers can be major reservoirs of infection with resistant types of pathogens that are difficult to treat. Acinetobacter, carbapenem-resistant Enterobacteriaceae, MRSA, Pseudomonas and vancomycin-resistant enterococci are typical, he said.
“It’s often chronic,” Kaye said. “Typically, what happens with patients that have chronic infections that cannot be medically eradicated is when they flare up and the infection is getting worse or they develop more puss and high fevers, they’re debrided, they’re managed, they’re given antibiotics, they’re left alone and they occur again. If you try to just chronically treat them, they end up with even more resistant pathogens that really are not treatable.”
Deficiencies in prevention
According to Kaye and colleagues, although medical and surgical treatment for pressure ulcers have progressed over the last decade, major deficiencies still exist in the prevention of pressure ulcers in gunshot paraplegic patients with spinal cord injuries. Among the health care reforms that are needed to address this gap, they said public-private collaboration should incentivize providers to effectively manage care for gunshot injury paraplegic patients with spinal cord injuries.
“Special paraplegic health clinics should be set up. These clinics should utilize a large team of multidisciplinary health care professionals, including internists, psychiatrists, surgeons, wound care nurses, physical therapists, nutritionists and social workers who can help improve the overall health of these patients,” the wrote.
Kaye said it is about being proactive and making sure there are enough resources for the patients.
“Once you start with these pressure ulcers, it’s just a vicious circle of exacerbation, antibiotics, treatment and getting worse,” he said. “There’s the prevention side of it, but there’s also the side for these individuals who have these horrendous types of infections, trying to find ways to give them hope and look forward toward a positive future.” – by Gerard Gallagher
Reference:
Chopra T, et al. Infect Control Hosp Epidemiol. 2017;doi:10.1017/ice.2017.33.
Disclosure: Kaye and the other authors report no relevant financial disclosures.