Abstract
Chart reviews were combined with neurological and functional outcome data obtained from the prospective European Multicenter Study on Spinal Cord Injury (EMSCI, www.emsci.org). To determine if strict physical isolation of multidrug-resistant organisms (MDRO)-positive patients negatively affects neurological recovery and functional outcome in the first year after acute spinal cord injury (SCI). SCI Center Heidelberg University Hospital. Individuals with acute (< 6 weeks) traumatic or ischemic SCI were included. During primary comprehensive care, isolated MDRO-positive patients (n = 13) were compared with a MDRO-negative control group (n = 13) matched for functional (Spinal Cord Independence Measure-SCIM) and neurological impairment (motor scores based on the International Standards for Neurological Classification of Spinal Cord Injury-ISNCSCI) at an early stage up to 40 days after SCI. SCIM scores and motor scores were obtained at 12 weeks (intermediate stage) and 24 or 48 weeks (late stage) after SCI. Isolated MDRO-positive (median duration of hospitalization: 175 days, 39% of inpatient stay under isolation measures) and non-isolated MDRO-negative (median duration of hospitalization: 161 days) patients showed functional and neurological improvements, which were not statistically different between groups at the intermediate and late stage. Prolonged isolation due to MDRO colonization for over a third of the inpatient comprehensive care period does not appear to impair neurological recovery and functional outcome within the first year after SCI.
Highlights
Colonization with multidrug-resistant organisms (MDRO) represents a growing problem in spinal cord injury (SCI) centers and other hospital care facilities as well
During primary comprehensive care, isolated MDRO-positive patients (n = 13) were compared with a MDRO-negative control group (n = 13) matched for functional (Spinal Cord Independence Measure–SCIM) and neurological impairment at an early stage up to 40 days after SCI
SCIM scores and motor scores were obtained at 12 weeks and 24 or 48 weeks after SCI
Summary
Colonization with multidrug-resistant organisms (MDRO) represents a growing problem in spinal cord injury (SCI) centers and other hospital care facilities as well. Many individuals with SCI have received initial intensive care unit treatment, which by itself increases the risk for MDRO colonization [3]. MRSA was identified as the most common MDRO colonizing patients with SCI [4]. Numerous risk factors for colonization with MRSA have been identified [7] Several of these conditions namely chronic skin conditions, tracheostomy with mechanical ventilation, antibiotic therapy, and high comorbidity are present in individuals with SCI. Beside screening and chemical decolonization, a strict isolation of colonized patients is recommended [9]. This isolation usually interferes with rehabilitative interventions such as physical or occupational therapy, which may have a negative impact on clinical outcome. Isolated individuals are deprived from social contacts [10]
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