Abstract
BackgroundColonization or infection with multi-drug resistant (MDR) bacteria is considered detrimental to the outcome of neurological and neurosurgical early rehabilitation patients.MethodsIn a German multi-center study, 754 neurological early rehabilitation patients were enrolled and and reviewed in respect to MDR status, length of stay (LOS) and the following outcome variables: Barthel Index (BI), Early Rehabilitation Index (ERI), Glasgow Outcome Score Extended (GOSE), Coma Remission Scale (CRS), Functional Ambulation Categories (FAC).ResultsThe mean age of the study population was 68.0 ± 14.8 years. Upon admission, the following prevalence for MDRs was observed: MRSA (methicillin resistant staphylococcus aureus) 7.0% (53/754), ESBL- (extended spectrum beta-lactamase) producing bacteria strains 12.6% (95/754), VRE (vancomycin resistant enterococci) 2.8% (21/754). Patients colonized or infected with MDR bacteria (MDR+) were significantly more frequently diagnosed with a critical illness polyneuropathy – CIP – than non-colonized (MDR-) patients: 29.0% vs. 14.8%. In addition, they were more frequently mechanically ventilated (MDR+: 55/138, 39.9%; MDR- 137/616, 22.2%). MDR+ patients were referred to rehabilitation earlier, had a longer LOS in early rehabilitation, lower BI on admission and at discharge, lower ERI on admission and lower CRS at discharge than MDR- patients. There was a highly significant correlation of the BI upon admission with the BI at discharge (rs = 0.492, p < 0.001). GOSE at discharge differed significantly between both groups (χ2-test, p < 0.01). Perhaps of greatest importance, mortality among MDR+ was higher in comparison to MDR- (18.1% vs. 7.6%).ConclusionsThe outcome of neurological early rehabilitation patients colonized or infected with MDR bacteria including MRSA or ESBL producing strains is significantly poorer than by non-colonized patients. There is some evidence that the poor outcome could be related to the higher morbidity and lower functional status upon admission.
Highlights
Colonization or infection with multi-drug resistant (MDR) bacteria is considered detrimental to the outcome of neurological and neurosurgical early rehabilitation patients
methicillin resistant Staphylococcus aureus (MRSA) prevalence was 7.0% (53/754), ESBLproducing bacteria were present in 12.6% (95/754), while vancomycin-resistant enterococci (VRE) were found in only 2.8% (21/754) of cases
Carriers of MRSA, extended spectrum beta-lactamase (ESBL)-producing germs or VRE were assigned to the multi-drug resistant positive (MDR+) group (138/754, 18.3%), all other patients were regarded as MDR negative (MDR-). 31 MDR+ patients were colonized with more than one MDR strain
Summary
Colonization or infection with multi-drug resistant (MDR) bacteria is considered detrimental to the outcome of neurological and neurosurgical early rehabilitation patients. In Germany, there exist an increasing number of specialized hospitals for early neurological and neurosurgical rehabilitation. These hospitals continue intensive and intermediate care treatment of patients who have been treated in intensive care units of acute-care facilities, who do not require specialized interventions but are still dependent on an intensive care setting. Colonization and/or infection with multi-drug resistant (MDR) bacteria including methicillin resistant Staphylococcus aureus (MRSA) or extended spectrum beta-lactamase (ESBL) producing gram-negative strains is a challenge in neurological and neurosurgical early rehabilitation. Other MDR strains including vancomycin-resistant enterococci (VRE) play a minor role, being present in only approximately 2.8% of cases [1]
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