Outcome of neurological early rehabilitation patients carrying multi-drug resistant bacteria: results from a German multi-center study.
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 (χ2-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.
Institute 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.
J D
JD
Rollnik
Kliniken Schmieder Heidelberg, Heidelberg, Germany.
M
M
Bertram
Neurologische Klinik Westend, Bad Wildungen, Germany.
C
C
Bucka
Asklepios Schlossberg Klinik Bad König, Bad König, Germany.
M
M
Hartwich
Brandenburg Klinik Bernau, Berlin, Germany.
M
M
Jöbges
Neurologisches Rehabilitationszentrum "Godeshöhe" Bonn, Bonn, Germany.
G
G
Ketter
Neurologische Klinik GmbH Bad Neustadt, Bad Neustadt an der Saale, Germany.
B
B
Leineweber
Schön Klinik Bad Aibling, Bad Aibling, Germany.
M
M
Mertl-Rötzer
Helios Klinik Kipfenberg, Kipfenberg, Germany.
D A
DA
Nowak
BDH-Klinik Greifswald, Greifswald, Germany.
T
T
Platz
Hegau-Jugendwerk Gailingen, Gailingen, Germany.
K
K
Scheidtmann
Asklepios Kliniken Schildautal Seesen, Seesen, Germany.
R
R
Thomas
Schön Klinik Bad Staffelstein, Bad Staffelstein, Germany.
F
F
von Rosen
BDH-Klinik Elzach, Elzach, Germany.
C W
CW
Wallesch
Neurologisches Rehabilitationszentrum Leipzig, Bennewitz, Germany.
H
H
Woldag
Department of Public Health, University of Dresden, Dresden, Germany.
P
P
Peschel
Department of Public Health, University of Dresden, Dresden, Germany.
J
J
Mehrholz
Klinik Schloss Pulsnitz, Pulsnitz, Germany.
M
M
Pohl
D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000453:epidemiology / Q000534:rehabilitation*; D015897:Comorbidity; D024901:Drug Resistance, Multiple, Bacterial; D061345:Early Medical Intervention / Q000379:methods*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000534:rehabilitation*; D000066530:Neurological Rehabilitation / Q000379:methods*; D017063:Outcome Assessment, Health Care
ESBL; Early rehabilitation; MRSA; Outcome