Infections and colonizations on admission to a rehabilitation hospital: involved microorganisms and resistance to carbapenems of Klebsiella pneumoniae according to the hospital ward of origin

Introduction Infections, in particular from multiresistant germs, represent a problem of great importance in the rehabilitative setting that gathers patients from areas that differ in complexity and intensity of care. The aim of the study is to describe infections and colonizations on admission to a rehabilitation hospital, assessing any possible difference between the wards of origin regarding the involved microorganisms and in particular Klebsiella pneumoniae resistant to carbapenems. Materials and methods During the period November 2015 - July 2018 surveys were conducted through a specific form designed for detecting healthcare-associated infections in the rehabilitative setting. For each infection or colonization on admission to the hospital, the antibiogram was collected, a database was set up with Redcap platform and data have been analyzed with Epi-info7 (CDC Atlanta). Results Seven hundred and ninety-nine patients were included, 405 (50.7%) of these were transferred from another hospital. Most of them were admitted from medical (251/405, 62.0%) or surgical (86/405, 21.2%) wards, while a minority of patients came from intensive and emergency care units (31/405, 7.7%), rehabilitation units (18/405, 4.4%) or other types of setting (9/405, 2.2%). The largest rate of infections/colonizations on admission was identified in patients coming from intensive and emergency care units (16/31, 51.6%), while a lower one from medical (87/251, 34, 6%), surgical (28/86, 32.5%) and rehabilitation units (4/18, 22.2%). Surveillance procedures with rectal swabs also identified a higher percentage of positive samples in patients admitted from intensive and emergency units (6/31, 19.4%) compared to those coming from the medical (18/251, 7.17%), surgical (8/86, 9.3%) and rehabilitative wards (0/18, 0.0%). The colonizing or infecting microorganisms were different according to the ward of origin. In particular Klebsiella pneumoniae was isolated in a high percentage of patients coming from a medical (13/116 isolates, 11.2%), surgical (8/46, 17.4%) and rehabilitation unit (4/7, 57.1%), together with Pseudomonas aeruginosa, Escherichia coli and, in the rectal swabs, Acinetobacter baumannii. On the other hand, in patients admitted from intensive and emergency care units Klebsiella pneumoniae was a minority of isolates (1/32, 3.1%), compared to other microorganisms such as Pseudomonas aeruginosa (4/32, 12.5%), Candida (4/32, 12.5%) and, in the rectal swab, Acinetobacter baumannii (5/32, 15.6%). Finally, from the analysis of the collected antibiograms, the resistance to carbapenems was related to 5/25 Klebsiellae (20.0%), isolated exclusively from rectal swabs. Patients came from medical (3/5) and surgical (2/5) wards. Conclusions Data confirm the importance of rigorous implementation of the surveillance/control measures of all the patients, even though admitted from units that differ in the level of care. Moreover, the rectal swab emerges as a fundamental tool for the active surveillance of multiresistant germs.