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

Giovanna Barbara Castellani; Elisa Maietti; Gloria Leonardi; Erik Bertoletti; Filippo Trapani; Alberto Battistini; Sara Tedeschi; Roberto Piperno; Pierluigi Viale

doi:10.3389/fneur.2023.1219862

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

Front Neurol. 2023 Aug 16:14:1219862. doi: 10.3389/fneur.2023.1219862. eCollection 2023.

Authors

Giovanna Barbara Castellani¹, Elisa Maietti², Gloria Leonardi³, Erik Bertoletti³, Filippo Trapani⁴, Alberto Battistini⁵, Sara Tedeschi⁶, Roberto Piperno⁵, Pierluigi Viale⁶

Affiliations

¹ Montecatone Rehabilitation Institute, Imola, Italy.
² Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Emilia-Romagna, Italy.
³ Department of Long-Term Care Rehabilitation, Santa Viola Hospital Colibrì Consortium, Bologna, Italy.
⁴ Infectious Disease Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
⁵ Rehabilitation Medicine and Neurorehabilitation Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
⁶ Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.

Abstract

Background: Recent 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).

Objective: This study aimed to estimate HAI incidence in different sABI rehabilitation settings and determine risk factors and HAI impact on neuromotor and cognitive recovery.

Methods: We 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.

Results: There 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.

Conclusion: HAIs 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.

Keywords: brain injuries; carbapenemase-producing Enterobacteriaceae; infections; multidrug resistance; rehabilitation outcome.