Abstract
BackgroundColonization with MRSA is believed to have deteriorating effects on neurological rehabilitation patients because MRSA carriers need to be isolated.MethodsMedical records of neurological early rehabilitation patients (most of them after stroke) admitted to a large rehabilitation facility in Northern Germany in 2010 have been carefully reviewed with respect to MRSA status, outcome variables (functional independence), morbidity, and length of stay (LOS).Results74/569 (13.0%) patients were MRSA positive on admission. MRSA carriers had a significantly longer LOS in early neurological rehabilitation (63.7 (37.1) vs. 25.8 (24.5) days, p < 0.001), worse functional status on admission (Barthel index (BI) 13.6 (9.9) vs. 25.6 (24.1), p < 0.001), worse Glasgow Coma Scale (9.5 (3.2) vs. 12.0 (3.3), p < 0.001), more co-diagnoses (20.5 (5.1) vs. 13.3 (5.5), p < 0.001), and higher Patient Clinical Complexity Levels (PCCL). The outcome was significantly worse among MRSA positive patients (BI 25.5 (21.2) vs. 47.4 (31.0), p < 0.001; Early Rehabilitation Index −47.3 (51.4) vs. -26.0 (35.4), p < 0.001). Isolated patients had slightly less therapy per day (131.6 (16.6) vs. 140.2 (18.7) min/day, p < 0.001), but the overall sum of therapy was significantly larger in the MRSA positive group due to longer LOS.ConclusionsFunctional recovery of MRSA carriers in early neurological rehabilitation is worse than in MRSA negative patients. Poorer outcome is not resulting from isolation (less therapy) but from functional status and higher morbidity on admission.
Highlights
Colonization with methicillin resistant Staphylococcus aureus (MRSA) is believed to have deteriorating effects on neurological rehabilitation patients because MRSA carriers need to be isolated
Poorer outcome is not resulting from isolation but from functional status and higher morbidity on admission
In the BDH Clinic Hessisch Oldendorf, we have found 6.6% MRSA positive patients on intensive and intermediate care wards [16], and a recent multicenter study revealed a rate of 14.5% among ten large neurological early rehabilitation facilities in Germany [17]
Summary
Colonization with MRSA is believed to have deteriorating effects on neurological rehabilitation patients because MRSA carriers need to be isolated. In 1982, the rate of MRSA colonized patients in a U. A decade ago, geriatric rehabilitation clinics have reported colonization rates ranging from 4.8% [3] to 9.8% [4]. It has been shown that MRSA positive have a significantly longer length of stay (LOS) than MRSA negative rehabilitants [4,5]. Strict isolation of these patients is still recommended [6,7,8] but raises ethical concerns [9]. Isolation may cause psychological distress like depression and anxiety [10]
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