1. Are the neurological rehabilitation wards at higher risk for multi-drug resistant micro-organisms infections? A retrospective analysis from a rehabilitation center in Northern Italy focusing on clinical risk factors n
M. Riccò1, D. Nicolotti2, C. Signorelli1, P. Camia1, S. Cattani1, V. Ciorba1, F. Pezzetti1, H. Cerrel Bazo2
1= Università degli Studi di Parma, Parma, Italy, 2 = AUSL Piacenza, Piacenza, Italy
Background: Patients admitted to neurological rehabilitation wards show high susceptibility to Urinary Tract Infections (UTI) by Multi-Drug Resistant (MDR) microorganisms (i.e. resistant to at least 1 antimicrobial in 3 or more antimicrobial classes). In particular carbapenem resistant Gram negative (CR-Gn) are globally associated with significantly increased morbidity and mortality
Objectives: Here we present a retrospective analysis of the epidemiology and risk factors for UTI and MDR pathogens associated UTI in a specialized neurological rehabilitation ward in Northern Italy.
Methods and Materials: The retrospective analysis included all patients admitted to G.Verdi Hospital in Villanova sull’Arda (Piacenza- Italy) between 10/2009 and 04/2012. Personal and clinical data were retrieved from medical records. All urinary isolates were analyzed focusing on identified pathogens and pharmacological resistances. A regression analysis (binary logistic regression) was then performed in order to evaluate an association between clinical data and MDR infections.
G. Verdi Hospital in Villanova sull’Arda is located in Northern Italy, between two of the most developed and populated Italian regions, Lombardia and Emilia Romagna .
Table 1. Main Personal and Clinical data.
Results: 543 patients were identified (Table 1); 222 of them had Spinal Cord Injuries (SCI) (40.9%), and 147 (27.1%) a previous diagnosis of stroke. In total, 462 urinary isolates (rate of 17.1 infections and 7.5 cases/1,000 hospital days) were retrieved (Table 2): 127 of them (23.3%) were MDR and 45 of them (10.7%) CR-Gn, with an increasing prevalence identified in linear regression analysis (r2=0.2022, p=0.0067; Figure 1). UTI were associated with hospital stay ≥60 days (Odds Ratio % Confidence Interval ), urinary incontinence (UIn) (OR %CI: ) and SCI (OR 2.03, 95%CI: ). Patients with SCI or stroke, ≤65-year-old, of male sex resulted also at higher risk for MDR (p<0.001) and CR-Gn infections (p<0.001). Site of medullary lesion in SCI, ataxia, aphasia or spatial neglect were not associated with an increased risk for UTI and MDR-infections.
Table 2. Isolates: microbiology and identified resistances.
Figure 1. Time trend of ratio MDR isolates / Total isolates with regression analysis (r2 = ; p = ).
Conclusion: With the limitations associated with a retrospective analysis, our data are consistent with the increasing prevalence of MDR-infections. In general, we identified higher risk for subjects with SCI, stroke or UIn. On the other hand, our data suggests that the Uin and prolonged hospital stays as the main risk factors for MDR and CR- Gn infections, whereas specific neurological impairment (i.e. level of the lesion in SCI, aphasia, ataxia, neglect) seems apparently unrelated.
Contacts: dr. Matteo Riccò – Strada Don Gnocchi n.6 – San Polo di Torrile Pr. Tel: