摘要
Colonization with multidrug-resistant germs, in particular methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum betalactamase producing bacteria (ESBL), is an emerging threat in early neurological rehabilitation. This study examined whether colonization with ESBL bacteria had deteriorating effects on neurological rehabilitation patients because of contact precautions (CP). Medical records have been carefully reviewed with respect to colonization with ESBL, outcome variables (functional independence), morbidity, and length of stay (LOS). 148/643 (23.0%) patients were ESBL positive on admission. ESBL carriers had a significantly longer LOS in early neurological rehabilitation (67.5 (42.0) vs. 25.8 (24.5), p < 0.001), worse functional status on admission (Barthel Index (BI) 13.0 (5.8) vs. 25.6 (24.1), p < 0.001), worse Glasgow Coma Scale (9.7 (3.8) vs. 12.0 (3.3), p < 0.001), worse Coma Remission Scale (9.5 (6.4) vs. 14.0 (6.8), p = 0.001), more codiagnoses (18.8 (5.1) vs. 13.3 (5.5), p < 0.001), and higher Patient Clinical Complexity Levels (PCCL). The outcome was significantly worse among ESBL positive patients (BI 28.2 (21.7) vs. 47.4 (31.0), p < 0.001;Early Rehabilitation Index -43.0 (51.7) vs. -26.0 (35.4), p < 0.001). ESBL patients had the same amount of therapy per day (136.2 (20.2) vs. 140.2 (18.7) min/day, n.s.), but the overall sum was significantly larger in the ESBL group due to longer LOS (p < 0.001). Mortality of both groups was comparable (3.8% vs. 4.1%). 54.3% of ESBL negative patients were discharged to home, but only 34.5% of ESBL colonized. 48% of ESBL positive patients were discharged to a nursing home, but only 25.1% of the ESBL free patients. Functional recovery of ESBL carriers undergoing neurological early rehabilitation is worse than that of patients without multidrug-resistant germs. Poorer outcome is not resulting from less therapy due to CP, but from functional status and higher morbidity on admission.
Colonization with multidrug-resistant germs, in particular methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum betalactamase producing bacteria (ESBL), is an emerging threat in early neurological rehabilitation. This study examined whether colonization with ESBL bacteria had deteriorating effects on neurological rehabilitation patients because of contact precautions (CP). Medical records have been carefully reviewed with respect to colonization with ESBL, outcome variables (functional independence), morbidity, and length of stay (LOS). 148/643 (23.0%) patients were ESBL positive on admission. ESBL carriers had a significantly longer LOS in early neurological rehabilitation (67.5 (42.0) vs. 25.8 (24.5), p < 0.001), worse functional status on admission (Barthel Index (BI) 13.0 (5.8) vs. 25.6 (24.1), p < 0.001), worse Glasgow Coma Scale (9.7 (3.8) vs. 12.0 (3.3), p < 0.001), worse Coma Remission Scale (9.5 (6.4) vs. 14.0 (6.8), p = 0.001), more codiagnoses (18.8 (5.1) vs. 13.3 (5.5), p < 0.001), and higher Patient Clinical Complexity Levels (PCCL). The outcome was significantly worse among ESBL positive patients (BI 28.2 (21.7) vs. 47.4 (31.0), p < 0.001;Early Rehabilitation Index -43.0 (51.7) vs. -26.0 (35.4), p < 0.001). ESBL patients had the same amount of therapy per day (136.2 (20.2) vs. 140.2 (18.7) min/day, n.s.), but the overall sum was significantly larger in the ESBL group due to longer LOS (p < 0.001). Mortality of both groups was comparable (3.8% vs. 4.1%). 54.3% of ESBL negative patients were discharged to home, but only 34.5% of ESBL colonized. 48% of ESBL positive patients were discharged to a nursing home, but only 25.1% of the ESBL free patients. Functional recovery of ESBL carriers undergoing neurological early rehabilitation is worse than that of patients without multidrug-resistant germs. Poorer outcome is not resulting from less therapy due to CP, but from functional status and higher morbidity on admission.
