{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T19:03:55Z","timestamp":1790103835108,"version":"4.0.1"},"reference-count":27,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"unspecified","delay-in-days":83,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,8,19]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Health equity means equal opportunities for all patients. While follow-up rehabilitation (German:\n                      <jats:italic>Anschlussheilbehandlung<\/jats:italic>\n                      (AHB)) improves patient-outcomes and reduces societal burdens of disease, patients colonised or infected with multidrug-resistant organisms (MDRO-carriers) have reportedly been denied admission by post-acute care (PAC) providers in Germany. This might however only be the tip of an \u2018iceberg\u2019, since carriers might drop out during earlier application processes. In this study, we quantify MDRO associated dropouts and model the odds of dropping out during different application stages.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study, including patients considered for transfer to \u2265281\u2009PAC providers (1 November 2015 to 31 October 2017) from a tertiary care teaching hospital. Breaking down the whole process to different stages, we modelled the odds of dropping out at every stage under the exposure to MDRO-carriage via multivariable logistic regression, adjusting for various covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Based on 12\u2009386 patient records, our data estimates that 45% (95% CI 36% to 54%) of MDRO-carriers considered for AHB do not receive AHB. This indicates that the proportion of carriers denied admission (13% (95% CI 7% to 19%)) is only the tip of the iceberg and that earlier dropouts exist. Provider decisions might have influenced earlier dropouts, since admission non-approvals increased the odds of proposal non-approvals (OR=4.85 (95% CI 4.24 to 5.54)) in multivariable regression. Thereby, strongest exposure signals were observed for carriers of vancomycin-resistant enterococci (VRE) compared with other MDRO-types.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Given the long-standing debate on the necessity of VRE-screening and the hardships of VRE-eradication, VRE-carriers in need of AHB would thus be further disadvantaged in addition to their already poorer conditions. This would lead to prolonged hospital stays, increased disability and ultimately elevated burden of disease and health expenditures at societal level. The balancing act between rehabilitation goals and adherence to best possible infection prevention measures would thus increase chances of carriers to receive much needed rehabilitation courses and ease individual as well as societal burdens.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2026-005242","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:35:21Z","timestamp":1790102121000},"page":"e005242","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the tip of the iceberg: quantifying the odds of multidrug-resistance carriers for receiving post-acute follow-up rehabilitation after hospital stay \u2013 a real-world study using German data"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8368-1407","authenticated-orcid":false,"given":"Hani E J","family":"Kaba","sequence":"first","affiliation":[{"name":"Department of Infection Control and Infectious Diseases, University Medical Center G\u00f6ttingen, G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8619-0254","authenticated-orcid":false,"given":"Paulina","family":"Wenzlaff-Lodge","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Infectious Diseases, University Medical Center G\u00f6ttingen, G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0773-4739","authenticated-orcid":false,"given":"Simone","family":"Scheithauer","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Infectious Diseases, University Medical Center G\u00f6ttingen, G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"2026092211351793000_4.3.e005242.1","doi-asserted-by":"publisher","DOI":"10.1016\/0167-6296(93)90004-X"},{"key":"2026092211351793000_4.3.e005242.2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(21)02724-0"},{"key":"2026092211351793000_4.3.e005242.3","first-page":"1199","article-title":"Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050","volume":"404","year":"2021","journal-title":"Lancet"},{"key":"2026092211351793000_4.3.e005242.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-015-2004-y","article-title":"The stigmatization dilemma in public health policy--the case of MRSA in Denmark","volume":"15","author":"Ploug","year":"2015","journal-title":"BMC Public Health"},{"key":"2026092211351793000_4.3.e005242.5","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.jhin.2016.09.010","article-title":"Signs of stigma and poor mental health among carriers of MRSA","volume":"95","author":"Rump","year":"2017","journal-title":"J Hosp Infect"},{"key":"2026092211351793000_4.3.e005242.6","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix411"},{"key":"2026092211351793000_4.3.e005242.7","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1016\/j.ajic.2025.05.013","article-title":"Moral tensions when providing care to MDRO carriers: A qualitative study among health care providers in Dutch hospitals and nursing homes","volume":"53","author":"Damst\u00e9","year":"2025","journal-title":"Am J Infect Control"},{"key":"2026092211351793000_4.3.e005242.8","article-title":"Management of patients with multidrug-resistant organisms in rehabilitation facilities. 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