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Outcome of neurological early rehabilitation patients carrying multi-drug resistant bacteria: results from a German
J D Rollnik1, M Bertram2, C Bucka3
1Institute for Neurorehabilitation Research (InFo), BDH-Klinik Hessisch Oldendorf, Hannover Medical School (MHH), Greitstr. 18-28, 31840, Hess. Oldendorf, Germany. prof.rollnik@bdh-klinik-hessisch-oldendorf.de.
Background:
Colonization or infection with multi-drug resistant (MDR) bacteria is considered detrimental to the outcome of neurological and neurosurgical early rehabilitation patients.
Methods:
In 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).
Results:
The 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 (χ 2-test, p < 0.01). Perhaps of greatest importance, mortality among MDR+ was higher in comparison to MDR- (18.1% vs. 7.6%).
Conclusions:
The 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.
Insights
Multi-drug resistant (MDR) bacteria infections in neurological rehabilitation patients lead to worse outcomes, including higher mortality and lower functional status. Early identification and management of MDR colonization are crucial for improving patient recovery.
Area of Science:
- Neurology
- Infectious Diseases
- Rehabilitation Medicine
Background:
- Colonization with multi-drug resistant (MDR) bacteria poses a significant threat to patients undergoing neurological and neurosurgical early rehabilitation.
- MDR infections are associated with poorer patient outcomes in this vulnerable population.
Purpose of the Study:
- To investigate the impact of MDR bacteria colonization/infection on the outcomes of neurological early rehabilitation patients.
- To compare the clinical characteristics and rehabilitation outcomes between MDR-colonized (MDR+) and non-colonized (MDR-) patients.
Main Methods:
- A multi-center study involving 754 neurological early rehabilitation patients in Germany.
- Assessment of MDR status, length of stay (LOS), and various outcome variables including Barthel Index (BI), Glasgow Outcome Score Extended (GOSE), and mortality.
- Comparison of clinical data between MDR+ and MDR- patient groups.
Main Results:
- MDR+ patients exhibited higher rates of critical illness polyneuropathy (CIP) and mechanical ventilation.
- MDR+ patients had poorer functional status on admission and discharge (lower BI, ERI, CRS) and longer LOS.
- Mortality was significantly higher in MDR+ patients (18.1%) compared to MDR- patients (7.6%).
Conclusions:
- Neurological early rehabilitation patients with MDR bacteria (including MRSA, ESBL-producing strains) experience significantly worse outcomes.
- Higher morbidity and lower functional status upon admission appear to contribute to the poorer outcomes observed in MDR+ patients.
