Epidemiology of Nosocomial Infection and Resistant Organisms in Patients Admitted for the First Time to an Acute Rehabilitation Unit

• Published in: Clinical infectious diseases Vol. 30; no. 3; pp. 425 - 432
• Main Authors: Mylotte, Joseph M., Graham, Robin, Kahler, Lucinda, Young, Lauren, Goodnough, Susan
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.03.2000; University of Chicago Press
• Subjects: Adult; Aged; Anti-Bacterial Agents - pharmacology; Antibiotics; APACHE; Bacteria - classification; Bacteria - drug effects; Bacteria - isolation & purification; Bacterial diseases; Bacterial Infections - epidemiology; Bacterial Infections - microbiology; Biological and medical sciences; Clinical Articles; Clostridium difficile; Cross Infection - epidemiology; Cross Infection - microbiology; Diarrhea; Drug Resistance, Microbial; Epidemiology; Escherichia coli; Female; Fungi - classification; Fungi - drug effects; Fungi - isolation & purification; Hospital admissions; Hospital units; Hospitalization; Human bacterial diseases; Humans; Infections; Infectious diseases; Male; Medical sciences; Middle Aged; Miscellaneous; Mycoses - epidemiology; Mycoses - microbiology; Physical trauma; Prospective Studies; Pseudomonas aeruginosa; Rehabilitation Centers; Spinal cord; Spinal Cord Injuries - rehabilitation; Staphylococcus aureus; Urinary tract infections; Infection; Human; Nosocomial infection; Intensive care; Risk factor; Bacteriosis; Rehabilitation; Predictive factor; Unit; Epidemiology
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/313708

The objectives of this study were to define the epidemiology of nosocomial bacterial colonization and infection and to define predictors of nosocomial infection among a cohort (n=423) of admissions to an acute rehabilitation unit. Overall, methicillin-resistant Staphylococcus aureus (MRSA) and enterococci were the most commonly identified colonizing organisms. Escherichia coli and Pseudomonas aeruginosa were the most commonly identified colonizing gram-negative bacilli. During 70 (16.5%) of the 423 hospitalizations in the unit, 94 nosocomial infections occurred. The most common infections were those of the urinary tract (30% of 94 infections) or a surgical site (17%), Clostridium difficile diarrhea (15%), and bloodstream infection (12.8%). Antibiotic-resistant bacteria most commonly caused bloodstream infection (41.7%) and surgical site infection (56.3%). Independent predictors of nosocomial infection at the time of admission were functional status (measured with the functional independence measure), APACHE III score, and spinal cord injury. In conclusion, gram-positive organisms were the predominant strains causing nosocomial colonization and infection. The logistic model, if verified, may be useful in defining patients who should be targeted for measures to prevent nosocomial infection.