Epidemiology of nosocomial infection and resistant organisms in patients admitted for the first time to an acute rehabilitation unit

The objectives of this study were to define the epidemiology of nosocomial bacterial colonization and infection and to define predictors of nosocomial infection among a cohort (n = 423) of admissions to an acute rehabilitatio n unit. Overall, methicillin-resistant Staphylococcus aureus (MRSA) and ent erococci were the most commonly identified colonizing organisms. Escherichi a coli and Pseudomonas aeruginosa were the most commonly identified coloniz ing gram-negative bacilli. During 70 (16.5%) of the 423 hospitalizations in the unit, 94 nosocomial infections occurred. The most common infections we re those of the urinary tract (30% of 94 infections) or a surgical site (17 %), Clostridium difficile diarrhea (15%), and bloodstream infection (12.8%) . Antibiotic-resistant bacteria most commonly caused bloodstream infection (41.7%) and surgical site infection (56.3%). Independent predictors of noso comial infection at the time of admission were functional status (measured with the functional independence measure), APACHE III score, and spinal cor d injury. In conclusion, gram-positive organisms were the predominant strai ns causing nosocomial colonization and infection. The logistic model, if ve rified, may be useful in defining patients who should be targeted for measu res to prevent nosocomial infection.