Skip to main content
×
×
Home

Nursing Home-Acquired Bloodstream Infection

  • Philip W. Smith and Joseph M. Mylotte (a1) (a2)
Abstract
Objectives:

This article reviews published studies of nursing home-acquired BSI in North America to determine whether there have been changes in the epidemiology of this infection in the past 20 years and to define indications for blood cultures in the nursing home setting.

Methods:

A Medline search was conducted for the period from 1980 to August 2003.

Results:

Seven studies of nursing home-acquired BSI were identified. The incidence of nursing home-acquired BSI was low (0.3 episode per 1,000 resident care-days). Sources of BSI changed little during the past two decades, with urinary tract infection representing approximately 50% of the episodes. The bacteriology also did not change substantially during the past 20 years; gram-negative bacilli were isolated in approximately 50% of the episodes and Escherichia coli was the most commonly isolated organism. In the most recent study, covering the period 1997-2000, resistance to fluoroquinolones and broad-spectrum penicillins and cephalosporins was uncommon among gram-negative blood isolates; MRSA was the most common resistant organism causing nursing home-acquired BSI. Case-fatality rates changed little during the past 20 years; urinary tract infection was associated with the lowest mortality and pneumonia had the highest case-fatality rate.

Conclusion:

There has been little change in the epidemiology of nursing home-acquired BSI in the past 20 years. Given the low incidence of BSI and the low overall yield of positive results of blood cultures (probably ≤ 6%), there is currently no support for the routine use of blood cultures in the nursing home setting.

Copyright
Corresponding author
Infectious Diseases, Erie County Medical Center, 462 Grider St., Buffalo, NY 14215mylotte@buffalo.edu
References
Hide All
1.Hoyert, KL, Kochanek, KD, Murphy, SL. Deaths: final data for 1997. VI 47. In: National Center for Health Statistics. National Vital Statistics Report 19. Hyattsville, MD: National Center for Health Statistics; 1999.
2.Simonsen, L, Conn, LA, Pinner, RW, Teutsch, S. Trends in infectious disease hospitalizations in the United States, 1980-1994. Arch Intern Med 1998;158:19231928.
3.McBean, M, Rajamani, S. Increasing rates of hospitalization due to septicemia in the US elderly population, 1986-1997. Clin Infect Dis 2001;183:596603.
4.Setia, U, Serventi, I, Lorenz, P. Bacteremia in a long-term care facility: spectrum and mortality. Arch Intern Med 1984;144:16331635.
5.Rudman, D, Hontanosas, A, Cohen, Z, Mattson, DE. Clinical correlates of bacteremia in a Veterans Administration extended care facility. J Am Geriatr Soc 1988;36:726732.
6.Muder, RR, Brennen, C, Wagener, MM, Goetz, AM. Bacteremia in a long-term care facility: a five-year prospective study of 163 consecutive episodes. Clin Infect Dis 1992;14:647654.
7.Nicolle, LE, Mclntyre, M, Hoban, D, Murray, D. Bacteremia in a long term care facility. Canadian Journal of Infectious Diseases 1994;5:130132.
8.Richardson, JP, Hricz, L. Risk factors for the development of bacteremia in nursing home patients. Archives of Family Practice 1995;4:785789.
9.Sinclair, D, Svendsen, A, Marrie, T. Bacteremia in nursing home patients: prevalence among patients presenting to an emergency department. Can Fam Physician 1998;44:317322.
10.Mylotte, JM, Tayara, A, Goodnough, S. Epidemiology of bloodstream infection in nursing home residents: evaluation in a large cohort from multiple homes. Clin Infect Dis 2002;35:14841490.
11.Naughton, BJ, Mylotte, JM, Tayara, A. Outcome of nursing home-acquired pneumonia: derivation and application of a practical model to predict 30 day mortality. J Am Geriatr Soc 2000;48:12921299.
12.Mulhausen, PL, Harrell, LJ, Weinberger, M, Kochersberger, GG, Feussner, JR. Contrasting methicillin-resistant Staphylococcus aureus in Veterans Affairs and community nursing homes. Am J Med 1996;100:2431.
13.Warren, JW. Providentia stuartii: a common cause of antibiotic-resistant bacteriuria in patients with long-term indwelling catheters. Rev Infect Dis 1986;8:6167.
14.Bonomo, RA. Multiple antibiotic-resistant bacteria in long-term care facilities: an emerging problem in the practice of infectious diseases. Clin Infect Dis 2000;31:14141422.
15.Bradley, SF. Issues in the management of resistant bacteria in long-term-care facilities. Infect Control Hosp Epidemiol 1999;20:362366.
16.Loeb, M. Antibiotic use in long-term care facilities: many unanswered questions. Infect Control Hosp Epidemiol 2000;21:680683.
17.Smith, PW, Seip, CW, Schaefer, SC, Bell-Dixon, C. Microbiologic survey of long-term care facilities. Am J Infect Control 2000;28:813.
18.Mylotte, JM, Goodnough, S, Tayara, A. Antibiotic-resistant organisms among long-term care facility residents on admission to an inpatient geriatrics unit: retrospective and prospective surveillance. Am J Infect Control 2001;29:139144.
19.Embil, J, Ramaotar, K, Romance, L, et al.Memicillin-resistant Sfaiyt fococciis aureus in tertiary care institutions on the Canadian prairies, 1990-1992. Infect Control Hosp Epidemiol 1994;15:646651.
20.Rezende, NA, Blumberg, HM, Metzger, BS, Larsen, NM, Ray, SM, McGowan, JE. Risk factors for methicillin-resistance among patients with Staphylococcus aureus bacteremia at the time of hospital admission. Am J Med Sci 2002;323:117123.
21.Johnson, LB, Bhan, A, Pawlak, J, Manzor, O, Saravolatz, LD. Changing epidemiology of community-onset methicillin-resistant Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol 2003;24:431435.
22.Lodise, TP, McKinnon, PS, Rybak, M. Prediction model to identify patients with Staphylococcus aureus bacteremia at risk for methicillin resistance. Infect Control Hosp Epidemiol 2003;24:655661.
23.Bentley, DW, Bradley, S, High, K, Schoenbaum, S, Taler, G, Yoshikawa, TT. Practice guideline for evaluation of fever and infection in long-term care facilities. Clin Infect Dis 2000;31:640645.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed