longterm functional outcome in patients with acquired infections after acute spinal cord injury objective to investigate whether prevalent hospitalacquired pneumonia and wound infection affect the clinical longterm outcome after acute traumatic spinal cord injury scimethods this was a longitudinal cohort study within the prospective multicenter national spinal cord injury database birmingham alabama we screened datasets of 3834 patients enrolled in 20 trial centers from 1995 to 2005 followed up until 2016 eligibility criteria were cervical sci and american spinal cord injury association impairment scale a b and c pneumonia or postoperative wound infections pnwi acquired during acute medical careinpatient rehabilitation were analyzed for their association with changes in the motor items of the functional independence measure fimmotor using regression models primary endpoint 5year followup pnwirelated mortality was assessed as a secondary endpoint 10year followupresults a total of 1203 patients met the eligibility criteria during hospitalization 564 patients 47 developed pnwi pneumonia n 540 postoperative wound infection n 11 pneumonia and postoperative wound infection n 13 adjusted linear mixed models after multiple imputation revealed that pnwi are significantly associated with lower gain in fimmotor up to 5 years after sci 74 points 95 confidence interval ci 115 to 33 adjusted cox regression identified pnwi as a highly significant risk factor for death up to 10 years after sci hazard ratio 165 95 ci 126 to 216conclusion hospitalacquired pnwi are predictive of propagated disability and mortality after sci pnwi qualify as a potent and targetable outcomemodifying factor pnwi prevention constitutes a viable strategy to protect functional recovery and reduce mortality pnwi can be considered as rehabilitation confounders in clinical trials