Bacteremia in a Long Term Care Facility

Abstract

Infect Dis 1 994; 5(3):130-132. Episodes of bacteremia identified in a long term care facility over a seven and a half-year period from July 1984 lo December 1991 were reviewed. 1\venly-nine episodes of bacteremia were identified. a rate of 4.35/100.000 patient-days. The most common infecting organisms were Escherichia coli (11 episodes) . Streptococcus pneumoniae (four). Proteus mirabilis (lhree). Staphy lococcus aureus (lhree) and Bacteroides species (two). The source of bacteremia was urimuy in 45o/o of patients. gastrointestinal in 17o/o, pneumonia in 14o/o, skin in 14o/o and unknown in 1 Oo/o. The overall case fa tali ly rate was 24o/o. bu l for lhe final six years of the review lhe case fatality rate was only 9 .5o/o. These observations report a rate of bacteremia 10-fold lower lhan reported from olher Norlh American long term care facilities and. potentially. a lower case fatality rate. The primary site of bacteremia. however. in long term care faci lities is U1e w·inary tract. R ESIDENTS OF LONG TERM CARE FACILITIES ARE ATincreased risk for infection because of associated comorbidities, interventions n ecessitated by chronic functional problems and, possib ly, because of institutionalization. Bacteremia is an important infection because it is generally associated with a high mortality. There is limited information available, however, that describes bacteremia occurring in long term care facilities. Studies reporting bacteremia in long term care facilities in the United States have identified urinary t ract infection as the most frequent source, and reported an incidence of about 0.3/1000 patient-days (1-3). The overall mortality has been 21 to 35%. The present study of bacteremia occurring in one long term care facility in Winnipeg, Manitoba over a seven and a half-year period was undertaken to exan1ine characteristics of bacteremia in the study population and to compare this experience with that reported from other facilities in North America. PATIENT AND METHODS Institution:The Deer Lodge Centre is a long term care facility that was formerly a Veteran's Hospital. Most residents are male, with a male: female ratio of approximately 3.5: 1. During the period of this review, from July 1984 to December 1991, the centre varied in size from 199 to 420 beds. The remain ing acute care beds in the facility were progressively eliminated during this period and replaced by beds for assessment and rehabilitation. short term respite admissions and further long term care beds. This review describes bacteremia in permanent resid ents in the long term care facility beds at this institution. Residents who became acutely ill were transferred to the acute care ward in the facility where parenteral therapy and more intensive nursing care could be provided. They were not transferred to an acute care facility unless specialized intervention such as surgery was required . 'Death not directly attributed to infection be due to infection if the resident was clinically not anticipated to die within the short term and no cause ...

Antibiotic Resistance in Nursing Homes

“…The reported variation likely reflects differences in patient populations and interventions in different institutions. The case/fatality ratio for bacteremic patients is 21 to 35% (Setia U & Al, 1984;Rudman D & Al, 1988;Muder RR & Al, 1992;Nicolle LE & Al, 1994a) and is consistent with reports of mortality rates in other populations in which similar organisms have been isolated. (Table 8 …”

“…Moreover, symptomatic urinary infection is reported as the diagnosis necessitating transfer from a nursing home to an acutecare facility in 1 to 8% of such transfers (Irvine P, 1984;Gordon WZ, & Al, 1985). The urinary tract is the most common source of bacteriemia in the institutionalized elderly, contributing to over 50% of episodes (Setia U & Al, 1984;Rudman D & Al, 1988;Muder RR & Al, 1992;Nicolle LE & Al, 1994a) with a case/fatality ratio of 16 to 23% (Setia U & Al, 1985;Muder RR & Al, 1992;Nicolle LE & Al, 1994a). The prevalence of indwelling urethral catheters in the nursing homes is 7 to 10% (Ribeiro BJ & Smith SR, 1985;Warren JW & Al, 1989;Kunin CM & Al, 1992).…”

“…The reported prevalence of pressure ulcers, has varied from 1,6 to up of 20% in different institutions (Michocki RJ & Lamy PP, 1976;Spector WD & Al, 1988;Branders GH & Al, 1990;Young JB & Dobrzanski S, 1992;Nicolle LE & Al, 1994a;Berlowitz DR & Al, 1996;Coleman EA & Al, 2002;Zulkowski K & Al, 2005), with an incidence as high as 10 to 30% patient per year (Berlowitz DR & Wilking SVB, 1989;Branders GH & Al, 1990), and as low as 3,4 to 4,8 episodes per 100000 resident days (Nicolle LE & Al, 1994b). Pressure ulcers are associated with increased mortality (Branders GH & Al, 1990;Livesley NJ & Chow A, 2002;Garcia AD & Thomas DR, 2006).…”

Infections and antibiotic resistance in nursing homes

“…Symptomatic urinary infection is reported as the diagnosis necessitating transfer from a nursing home to an acute-care facility in 1 to 8% of such transfers (60,72). The urinary tract is the most common source of bacteremia in the institutionalized elderly, contributing to over 50% of episodes (102,115,137,144), with a case/fatality ratio of 16 to 23% (102,115,145). Bacteremia occurs significantly more frequently in subjects with indwelling urinary catheters (102,137).…”

Surveillance Definitions of Infections in Long-Term Care Facilities: Revisiting the McGeer Criteria

“…In 2005, Mylotte 37 reviewed several studies evaluating nursing home–associated BSI. Only 1 reported on the total numbers of blood cultures obtained during the study period, 38 and 1 reported the proportion of contaminated blood cultures (“false positives”). 39 None of the studies in the review had data more recent than from 2000.…”