Carbapenemase-producing Enterobacteriaceae in an inpatient post-acute care facility: impact on time to functional recovery - 10/12/21

Doi : 10.1016/j.rehab.2021.101621

Noureddine Henoun Loukili ¹, Jean-François Jusot ², Etienne Allart ³, Gael Celani ⁴, Agnes Perrin ¹, Olivier Gaillot ⁵, Anne Blanchard ⁶, Vinciane Pardessus ⁴, André Thevenon ^6,⁷, Vincent Tiffreau ^6,^7,^⁎
¹ Infection Control Unit, University Hospital of Lille, F-59000, Lille, France
² Department of Medical Informatics, University Hospital of Lille, F-59000, Lille, France
³ CHU Lille, Neurorehabilitation Unit, University Hospital of Lille, F-59000 Lille, France; University of Lille, INSERM UMR-S-1172 - Lille Neuroscience and Cognition, F-59000 Lille, France
⁴ General Rehabilitation Unit, University Hospital of Lille, F-59000, Lille France
⁵ Microbiology, University Hospital of Lille, F-59000, Lille, France
⁶ Physical and Rehabilitation Medicine, University Hospital of Lille, F-59000, Lille France
⁷ ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, University of Lille, F-59000, Lille

^⁎Corresponding author. Service de MPR, Hôpital Swynghedauw, rue André Verhaeghe, 59000 Lille, France. Tel.: +33 3 20 44 58 31Service de MPR, Hôpital Swynghedauwrue André VerhaegheLille59000France

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Highlights

•	Carbapenemase-producing Enterobacteriaceae was monitored in post-acute care.
•	The functional independence measure was measured on admission and discharge.
•	Functional recovery was defined on the basis of this difference.
•	The time to functional recovery (TTFR) was estimated by a survival analysis approach.
•	Carbapenemase-producing Enterobacteriaceae-positive status is associated with a longer time to functional recovery.

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Abstract

Background. The carriage of carbapenemase-producing Enterobacteriaceae (CPE) might lengthen the time to functional recovery (TTFR) for inpatients in post-acute care (PAC) units.

Objective. We aimed to assess the impact of CPE carriage on TTFR in a PAC facility.

Methods. This 2-year retrospective cohort study included 20 CPE-positive patients and 54 CPE-negative patients admitted to 3 PAC units (general, orthopaedic and neurologic rehabilitation units) in a teaching hospital from January 2017 to December 2019. Potential risk factors and demographic data were collected from patients’ medical records, the French national hospital discharge database, and the hospital's CPE surveillance database. Functional recovery was defined as the median difference in functional independence measure (FIM) between admission and discharge from each unit. Survival analysis and multiple Cox regression models were used to predict the TTFR and identify factors associated with functional recovery.

Results. The overall median [interquartile range] TTFR was 50 days [36–66]. Longer median TTFR was associated with CPE carriage (63 vs 47 days in the CPE-negative group; adjusted hazard ratio (aHR) 0.35, 95% CI 0.13–0.97) and presence of a peripheral venous catheter (aHR 3.51, 1.45–8.46); shorter TTFR was associated with admission to an orthopaedic versus general rehabilitation unit (aHR 3.11, 1.24–7.82).

Conclusions. CPE carriage in inpatient PAC facilities was associated with long TTFR. Further studies are needed to explore the mechanisms involved in these adverse events and to identify possible preventive measures.

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Keywords : post-acute care, carbapenemase-producing Enterobacteriaceae, nosocomial, functional independence measure

Abbreviations : CPE, FIM, LOS, PAC, PVC, RU, TTFR