Healthcare-Associated Infections in Subjects With Severe Acquired Brain Injury: The Effect of Microbial Colonization on the Functional Outcome. Data From a Multicenter Observational Study

Bartolo, Michelangelo; Zucchella, Chiara; Aabid, Hend; Valoriani, Beatrice; Mancuso, Mauro; Intiso, Domenico

doi:10.3389/fneur.2020.563275

Cited by 4 publications

(4 citation statements)

References 46 publications

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“…In line with Bartolo et al ( 6 ), our results indicate that CPE colonization was a significant risk factor for higher disability (higher DRS score) at discharge. This result highlights the importance of minimizing the risk of CPE colonization during inpatient rehabilitation.…”

Section: Discussionsupporting

confidence: 93%

“…Finally, we investigated the hospital LOS and found that patients with HAI had a longer LOS; moreover, in SICU, MDR HAI was associated with a higher LOS as compared to HAI. The significantly higher LOS for infected patients was also reported in other studies ( 5 , 6 ).…”

Section: Discussionsupporting

confidence: 86%

“…Recent studies underscore that HAI and multidrug-resistant (MDR) HAIs affect rehabilitation outcomes and the hospital length of stay (LOS) for sABI patients ( 5 ). Research on HAIs and MDR HAIs, especially in rehabilitation and neurorehabilitation settings, is scant ( 6 ). The HAI prevalence among patients admitted to Rehabilitation Units in Europe has been reported to be approximately 8 to 15% ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

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Healthcare-associated infections and antimicrobial resistance in severe acquired brain injury: a retrospective multicenter study

Castellani,

Maietti,

Leonardi

et al. 2023

Front. Neurol.

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BackgroundRecent studies underscore that healthcare-associated infections (HAIs) and multidrug-resistant (MDR) HAIs affect rehabilitation outcomes and hospital length of stay (LOS) for severe acquired brain injury (sABI).ObjectiveThis study aimed to estimate HAI incidence in different sABI rehabilitation settings and determine risk factors and HAI impact on neuromotor and cognitive recovery.MethodsWe conducted a retrospective multicenter study in two semi-intensive units (SICUs), two high-specialty post-acute units (PAUs), and one long-term care (LTC) rehabilitation facility. Data extraction was performed by experienced clinicians, using a structured Excel file and they agreed upon criteria for case definitions of healthcare. The main outcome measures were the HAI and MDR HAI incidence and the LOS, the functional recovery was measured using the Level of Cognitive Functioning and Disability Rating Scale.ResultsThere were 134 sABI participants. The calculation of the probability level was adjusted for three pairwise comparisons among settings (0.05/3 = 0.017). The HAI and MDR HAI incidences were significantly higher in SICU (3.7 and 1.3 per 100 person-days) than in other settings (LTC: 1.9, p = 0.034 and 0.5, p = 0.026; PAU: 1.2, p < 0.001 and 0.3, p < 0.001). HAI and MDR HAI risk variables included older age, an increased number of devices, and carbapenemase-producing Enterobacteriaceae (CPE) colonization, while a high prealbumin plasma value seemed to have a protective effect.ConclusionHAIs are related to longer LOS, and colonization is associated with poor prognosis and poor functional outcomes with reduced ability to achieve the cognitive capacity of self-care, employability, and independent living. The need to ensure the protection of non-colonized patients, especially those with severe disabilities on admission, is highlighted.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

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Healthcare-associated infections and antimicrobial resistance in severe acquired brain injury: a retrospective multicenter study

Castellani,

Maietti,

Leonardi

et al. 2023

Front. Neurol.

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“…While the effect of colonization on rehabilitation outcome was not considered in the cited study [17], the same author [21] wrote about colonization in 2020 and concluded that HAIs and microbial colonization were common in patients with SABI admitted to neurorehabilitation units. Patients with colonized SABI had a similar functional outcome to those without infection.…”

Section: Discussionmentioning

confidence: 99%

Impact of Multidrug-Resistant Organisms on Severe Acquired Brain Injury Rehabilitation: An Observational Study

Castellani,

Maietti,

Colombo

et al. 2024

Microorganisms

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Healthcare-associated infections (HAIa) and antimicrobial resistance are expected to be the next threat to human health and are most frequent in people with severe acquired brain injury (SABI), who can be more easily colonized by multidrug-resistant organisms (MDROs). The study’s aim is to investigate the impact of MDRO colonizations and infections on SABI rehabilitation outcomes. This retrospective observational study was performed in a tertiary referral specialized rehabilitation hospital. The main outcomes were the presence of carbapenemase-producing Enterobacteriaceae (CPE) colonization, type and timing of HAI and MDRO HAI, and the number of CPE transmissions. We included 48 patients, 31% carrying CPE on admission and 33% colonized during the hospitalization. A total of 101 HAI were identified in 40 patients, with an overall incidence of 10.5/1000 patient days. Some 37% of patients had at least one MDRO infection, with a MDRO infection incidence of 2.8/1000 patient days. The number of HAIs was significantly correlated with the length of stay (LOS) (r = 0.453, p = 0.001). A significant correlation was found between colonization and type of hospital room (p = 0.013). Complications and HAI significantly affected LOS. We suggest that CPE carriers might be at risk of HAI and worse outcomes compared with non-CPE carriers.

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Telerehabilitation in response to constrained physical distance: an opportunity to rethink neurorehabilitative routines

et al. 2021

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Ensuring proper dosage of treatment and repetition over time is a major challenge in neurorehabilitation. However, a requirement of physical distancing to date compromises their achievement. While mostly associated to COVID-19, physical distancing is not only required in a pandemic scenario, but also advised for several clinical conditions (e.g. immunocompromised individuals) or forced for specific social contexts (e.g. people living in remote areas worldwide). All these contexts advocate for the implementation of alternative healthcare models. The objective of this perspective is to highlight the benefits of remote administration of rehabilitative treatment, namely telerehabilitation, in counteracting physical distancing barriers in neurorehabilitation. Sustaining boosters of treatment outcome, such as compliance, sustainability, as well as motivation, telerehabilitation may adapt to multiple neurological conditions, with the further advantage of a high potential for individualization to patient's or pathology's specificities. The effectiveness of telerehabilitation can be potentiated by several technologies available to date: virtual reality can recreate realistic environments in which patients may bodily operate, wearable sensors allow to quantitatively monitor the patient's performance, and signal processing may contribute to the prediction of long-term dynamics of patient recovery. Telerehabilitation might spark its advantages far beyond the mere limitation of physical distancing effects, mitigating criticalities of daily neurorehabilitative practice, and thus paving the way to the envision of mixed models of care, where hospital-based procedures are complementarily integrated with telerehabilitative ones.

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Healthcare-Associated Infections in Subjects With Severe Acquired Brain Injury: The Effect of Microbial Colonization on the Functional Outcome. Data From a Multicenter Observational Study

Cited by 4 publications

References 46 publications

Healthcare-associated infections and antimicrobial resistance in severe acquired brain injury: a retrospective multicenter study

Healthcare-associated infections and antimicrobial resistance in severe acquired brain injury: a retrospective multicenter study

Impact of Multidrug-Resistant Organisms on Severe Acquired Brain Injury Rehabilitation: An Observational Study

Telerehabilitation in response to constrained physical distance: an opportunity to rethink neurorehabilitative routines

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