Healthcare-associated infections and antimicrobial resistance in severe acquired brain injury: a retrospective multicenter study
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 rehabilit...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-08-01
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| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1219862/full |
| _version_ | 1797741728238665728 |
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| author | Giovanna Barbara Castellani Elisa Maietti Gloria Leonardi Erik Bertoletti Filippo Trapani Alberto Battistini Sara Tedeschi Roberto Piperno Pierluigi Viale |
| author_facet | Giovanna Barbara Castellani Elisa Maietti Gloria Leonardi Erik Bertoletti Filippo Trapani Alberto Battistini Sara Tedeschi Roberto Piperno Pierluigi Viale |
| author_sort | Giovanna Barbara Castellani |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-12T14:30:50Z |
| format | Article |
| id | doaj.art-e4278379ad0f4bb7aef7ede9d3a9fe87 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-12T14:30:50Z |
| publishDate | 2023-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-e4278379ad0f4bb7aef7ede9d3a9fe872023-08-17T13:38:53ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-08-011410.3389/fneur.2023.12198621219862Healthcare-associated infections and antimicrobial resistance in severe acquired brain injury: a retrospective multicenter studyGiovanna Barbara Castellani0Elisa Maietti1Gloria Leonardi2Erik Bertoletti3Filippo Trapani4Alberto Battistini5Sara Tedeschi6Roberto Piperno7Pierluigi Viale8Montecatone Rehabilitation Institute, Imola, ItalyDepartment of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Emilia-Romagna, ItalyDepartment of Long-Term Care Rehabilitation, Santa Viola Hospital Colibrì Consortium, Bologna, ItalyDepartment of Long-Term Care Rehabilitation, Santa Viola Hospital Colibrì Consortium, Bologna, ItalyInfectious Disease Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalyRehabilitation Medicine and Neurorehabilitation Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, ItalyDepartment of Medical and Surgical Sciences, University of Bologna, Bologna, ItalyRehabilitation Medicine and Neurorehabilitation Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, ItalyDepartment of Medical and Surgical Sciences, University of Bologna, Bologna, ItalyBackgroundRecent 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.https://www.frontiersin.org/articles/10.3389/fneur.2023.1219862/fullrehabilitation outcomebrain injuriesinfectionsmultidrug resistancecarbapenemase-producing Enterobacteriaceae |
| spellingShingle | Giovanna Barbara Castellani Elisa Maietti Gloria Leonardi Erik Bertoletti Filippo Trapani Alberto Battistini Sara Tedeschi Roberto Piperno Pierluigi Viale Healthcare-associated infections and antimicrobial resistance in severe acquired brain injury: a retrospective multicenter study Frontiers in Neurology rehabilitation outcome brain injuries infections multidrug resistance carbapenemase-producing Enterobacteriaceae |
| title | Healthcare-associated infections and antimicrobial resistance in severe acquired brain injury: a retrospective multicenter study |
| title_full | Healthcare-associated infections and antimicrobial resistance in severe acquired brain injury: a retrospective multicenter study |
| title_fullStr | Healthcare-associated infections and antimicrobial resistance in severe acquired brain injury: a retrospective multicenter study |
| title_full_unstemmed | Healthcare-associated infections and antimicrobial resistance in severe acquired brain injury: a retrospective multicenter study |
| title_short | Healthcare-associated infections and antimicrobial resistance in severe acquired brain injury: a retrospective multicenter study |
| title_sort | healthcare associated infections and antimicrobial resistance in severe acquired brain injury a retrospective multicenter study |
| topic | rehabilitation outcome brain injuries infections multidrug resistance carbapenemase-producing Enterobacteriaceae |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1219862/full |
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