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

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

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1219862

DOI=10.3389/fneur.2023.1219862

ISSN=1664-2295

ABSTRACT=Acquired Brain Injury: a retrospective multicenter studyRecent studies underscored 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).To estimate HAI incidence in different sABI rehabilitation settings; to determine risk factors and HAI impact on neuromotor and cognitive recovery.We conducted a retrospective multicenter study in 2 semi-intensive units (SICU), 2 high specialty post-acute units (PAU), one long-term care rehabilitation facility (LTC). Data extraction was made by experienced clinicians, using a structured excel file and agreed criteria on case definitions of healthcare. Main outcome measures were HAI and MDR HAI incidence, LOS and functional recovery measured with Level of Cognitive Functioning and Disability Rating Scale.Participants were 134 sABI. The calculation of probability level was adjusted for three pairwise comparisons among settings (0.05/3=0.017). HAI and MDR HAI incidence was 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).Older age, an increased number of devices and Carbapenemase-producing Enterobacteriaceae (CPE) colonization were HAI and MDR HAI significant risk factors, while a high prealbumin plasma value seemed to have a protective effect.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 selfcare, employability and independent living. The need to ensure the protection of noncolonized patients, especially of those with severe disabilities on admission, is highlighted.