Outcome of neurological early rehabilitation patients carrying multi-drug resistant bacteria: results from a German multi-center study

• Published in: BMC neurology Vol. 17; no. 1; p. 53
• Main Authors: Rollnik, J D, Bertram, M, Bucka, C, Hartwich, M, Jöbges, M, Ketter, G, Leineweber, B, Mertl-Rötzer, M, Nowak, D A, Platz, T, Scheidtmann, K, Thomas, R, von Rosen, F, Wallesch, C W, Woldag, H, Peschel, P, Mehrholz, J, Pohl, M
• Format: Journal Article
• Language: English
• Published: England BioMed Central 20.03.2017
• Subjects: Aged; Aged, 80 and over; Bacteria; Bacterial Infections - epidemiology; Bacterial Infections - rehabilitation; Colonization; Coma; Comorbidity; Drug resistance; Drug Resistance, Multiple, Bacterial; Early Medical Intervention - methods; Female; Germany - epidemiology; Hospitalization - statistics & numerical data; Humans; Hygiene; Intensive care; Male; Methicillin; Middle Aged; Morbidity; Multidrug resistance; Nervous System Diseases - epidemiology; Nervous System Diseases - rehabilitation; Neurological Rehabilitation - methods; Neurosurgery; Outcome Assessment, Health Care; Patients; Polyneuropathy; Population studies; Prevention; Rehabilitation; Remission; Staphylococcus aureus; Staphylococcus infections; Strains (organisms); Stroke; Vancomycin; Ventilators; Weaning; Germany; ESBL; Outcome; MRSA; Early rehabilitation
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/s12883-017-0833-2

Colonization or infection with multi-drug resistant (MDR) bacteria is considered detrimental to the outcome of neurological and neurosurgical early rehabilitation patients. 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). 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 (r  = 0.492, p < 0.001). GOSE at discharge differed significantly between both groups (χ -test, p < 0.01). Perhaps of greatest importance, mortality among MDR+ was higher in comparison to MDR- (18.1% vs. 7.6%). 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.