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Outcome of MRSA carriers in neurological early rehabilitation
1Institute for Neurorehabilitational Research (InFo), BDH-Clinic Hessisch Oldendorf, Teaching Hospital of Hannover Medical School, BDH-Clinic Hessisch Oldendorf, Greitstr, 18-28, 31840 Hess, Oldendorf, Germany. prof.rollnik@bdh-klinik-hessisch-oldendorf.de.
Background:
Colonization with MRSA is believed to have deteriorating effects on neurological rehabilitation patients because MRSA carriers need to be isolated.
Methods:
Medical 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).
Results:
74/569 (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.
Conclusions:
Functional 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.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) colonization negatively impacts neurological rehabilitation outcomes. MRSA carriers experience longer hospital stays and poorer functional recovery, not due to isolation, but due to their initial health status.
Area of Science:
- Neurology
- Infectious Diseases
- Rehabilitation Medicine
Background:
- Colonization with Methicillin-resistant Staphylococcus aureus (MRSA) is a concern in healthcare settings.
- MRSA carriers in neurological rehabilitation may face isolation, potentially affecting care.
- The impact of MRSA on neurological rehabilitation outcomes requires further investigation.
Purpose of the Study:
- To evaluate the effect of MRSA colonization on neurological rehabilitation patients.
- To compare outcomes, including functional independence and length of stay, between MRSA-positive and MRSA-negative patients.
- To determine factors contributing to poorer outcomes in MRSA carriers.
Main Methods:
- Retrospective review of medical records for neurological early rehabilitation patients.
- Data collected included MRSA status, functional independence (Barthel Index, Glasgow Coma Scale), morbidity, and length of stay (LOS).
- Analysis compared outcomes between MRSA-positive and MRSA-negative patient groups.
Main Results:
- 13.0% of patients admitted were MRSA positive.
- MRSA carriers exhibited significantly longer LOS (63.7 vs. 25.8 days) and worse functional status on admission (BI: 13.6 vs. 25.6).
- Poorer outcomes were observed in MRSA-positive patients, with significantly worse functional recovery (BI: 25.5 vs. 47.4).
Conclusions:
- MRSA colonization is associated with worse functional recovery in early neurological rehabilitation.
- The poorer outcomes are linked to patients' initial functional status and higher morbidity, not isolation-related therapy reduction.
- Early identification and management of MRSA in neurological rehabilitation are crucial for improving patient outcomes.
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