Bacteremia in Veterans Administration Nursing Home Patients

Abstract

The objective of this study was to identify differences between nursing home (NH) and nonnursing home (non-NH) patients with bacteremia regarding host risk factors, exposures, microbiology, and outcome. Between October 1995 and February 1998, 134 episodes of true bacteremia were identified at the North Chicago Veterans Administration Medical Center (NCVAMC). Seventy-eight episodes of bacteremia occurred in NH patients who stayed for at least 3 months in the NH at the NCVAMC and developed bacteremia there or 48 hours after admission to the acute care hospital (ACH). Fifty-six episodes occurred in the non-NH patients who developed bacteremia in the community or 48 hours after admission to the ACH. NH patients were more likely to be older than 65 years (88% vs. 71%, P = 0.0334) and to have pressure sores (25% vs. 5%, P = 0.005), urinary incontinence (42% vs. 27%, P = 0.0471), and mental illness (62% vs. 29%, P = 0.0001) than non-NH patients. Coagulase-negative Staphylococcus and Escherichia coli were the most common causes of bacteremia occurring as frequently in both groups. Methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and enterococcal bacteremia were comparable, whereas vancomycin-resistant enterococci, ceftazidime-resistant E. coli, Klebsiella pneumoniae, and Enterobacter were rarely isolated. Twelve (15%) NH patients died within 2 weeks of acquiring bacteremia compared with 4 (7%) non-NH patients (P = 0.1176). For ACH-acquired cases, 20 NH patients were similar to 26 non-NH patients with regard to hospital stay; exposure to antibiotics, steroids, intensive care setting, surgery, tube feeding, and urinary and vascular catheters prior to bacteremia. Although NH and non-NH patients with bacteremia have different host characteristics, they have similar in-hospital exposures, distribution of infecting organisms, and outcome.

Bloodstream Infections in the Elderly: Effects of Nursing Homes on Antimicrobial-Resistant Bacteria

“…Furthermore, the most common nursing-home-associated gram-positive bacterium isolated in our study was MRCNS, which corresponds with results proposed by Khayr et al 11 . In addition, the proportion of nursinghome-associated BSIs caused by MRSA, P. aeruginosa, and A. baumannii were also similar to previous reports.…”

Nursing home-associated bloodstream infection: A scoping review

“…The literature review identified 1 study 7 of NHABSI published in 2004 that covered the period 1995-1998 and was not included in the 2005 review 1 because that review included studies published between 1980 and 2003. The findings of this study 7 were consistent with studies in the 2005 review 1 and will not be discussed further. The literature review identified 6 studies published since 2005 that met the inclusion criteria [8][9][10][11][12][13] : 2 studies evaluated exclusively NHABSI 8,9 and 4 studies compared NHABSI to community-or hospital-associated BSI.…”