Bartolo Michelangelo, Zucchella Chiara, Aabid Hend, Valoriani Beatrice, Mancuso Mauro, Intiso Domenico
Neurorehabilitation Unit, Department of Rehabilitation, HABILITA Zingonia, Bergamo, Italy.
Neurology Unit, University Hospital of Verona, Verona, Italy.
Front Neurol. 2020 Nov 10;11:563275. doi: 10.3389/fneur.2020.563275. eCollection 2020.
Hospital-acquired infections (HAIs) and microbial colonization are a worldwide serious threat for human health. Neurological patients with infections who undergo rehabilitation have a significantly poor recovery. The effect of microbial colonization on the functional outcome in severe acquired brain injury (sABI) subjects is still unclear. The aim of this multicenter observational study was to describe the clinical impact of HAIs and colonization on the functional outcome of sABI subjects admitted to inpatient neurorehabilitation. Patients were assigned to three groups: infected (INF), not infected (noINF), and colonized (COL). The Glasgow Coma Scale (GCS), the Rancho Los Amigos Levels of Cognitive Functioning Scale, Disability Rating Scale, and modified Barthel Index (mBI) assessments were performed both at admission and discharge. Two hundred sixty-five (92 female/173 male) patients were enrolled: 134 were assigned to INF, 63 to COL, and 68 to noINF. In the INF group, 231 culture specimens were found positive for bloodstream (44.2%), respiratory tract (25.5%), urinary tract (18.6%), gastrointestinal tract (8.3%), skin (3%), and cerebrospinal fluid (0.4%) infections. After rehabilitation, all groups showed a significant improvement in all assessment tests, except for the noINF group that did not show any improvement in GCS. Both noINF and COL groups showed a significantly higher gain in mBI than the INF group ( = 0.000). The COL group showed a significantly higher gain than the noINF group in GCS ( = 0.001). A significantly lower improvement was detected in the INF group than the COL and noINF groups. The rate of patients who needed functional isolation was higher in the INF group than the COL group. Length of stay (LOS) (in days) was 56 ± 50.7, 88.3 ± 55, and 101.3 ± 73.6 for noINF, INF, and COL groups, respectively. The number of deaths in the INF group was significantly higher (24.6%) than the noINF group (7.4%) ( = 0.005) and comparable to the COL group (19%). Colonized sABI patients obtained a similar functional outcome to that of subjects who had no infections, even if they needed a significantly higher LOS.
医院获得性感染（HAIs）和微生物定植是全球范围内对人类健康的严重威胁。接受康复治疗的感染性神经疾病患者恢复情况明显较差。微生物定植对重度获得性脑损伤（sABI）患者功能结局的影响仍不清楚。这项多中心观察性研究的目的是描述医院获得性感染和定植对入住住院神经康复科的sABI患者功能结局的临床影响。患者被分为三组：感染组（INF）、未感染组（noINF）和定植组（COL）。在入院时和出院时均进行格拉斯哥昏迷量表（GCS）、兰乔斯阿米戈斯认知功能水平量表、残疾评定量表和改良巴氏指数（mBI）评估。共纳入265例患者（92例女性/173例男性）：134例被分配到INF组，63例被分配到COL组，68例被分配到noINF组。在INF组中，231份培养标本被发现血液（44.2%）、呼吸道（25.5%）、泌尿道（18.6%）、胃肠道（8.3%）、皮肤（3%）和脑脊液（0.4%）感染呈阳性。康复后，所有组在所有评估测试中均有显著改善，但noINF组在GCS方面没有任何改善。noINF组和COL组在mBI方面的改善均显著高于INF组（P = 0.000）。COL组在GCS方面的改善显著高于noINF组（P = 0.001）。检测到INF组的改善明显低于COL组和noINF组。INF组中需要功能隔离的患者比例高于COL组。无感染组、感染组和定植组的住院时间（LOS）（以天为单位）分别为56±50.7、88.3±55和101.3±73.6。INF组的死亡人数显著高于noINF组（24.6%比7.4%）（P = 0.005），与COL组（19%）相当。定植的sABI患者获得了与未感染患者相似的功能结局，尽管他们需要显著更长的住院时间。
