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

Abstract

s u m m a r yObjectives: Emergency room visits by nursing home patients with bloodstream infections (BSIs) are not uncommon and pose challenges to clinicians when selecting appropriate antimicrobial agents. This research aims to discover distinct bacteriology in nursing home patients by focusing particularly on antimicrobial-resistant bacteria. Methods: This retrospective study enrolled patients aged 65 years or older who had documented positive blood culture reports between May 2006 and June 2008. Patients were further categorized into subgroups according to nursing home history and the timely trend of hospital exposure. Results: The adjusted risk of BSIs associated with nursing home exposure was significantly higher in Methicillin-resistant Staphylococcus aureus (odds ratio (OR) 2.0; 95% CI 1.5e2.8), Methicillin-resistant coagulase-negative Staphylococcus species (OR 1.7; 95% CI 1.2e2.5), and Enterobacteriaceae-extended spectrum b-lactamase-producing Enterobacteriaceae (OR 2.4; 95% CI 1.5e3.9), but not in Pseudomonas aeruginosa (OR 1.4; 95% CI 0.9e2.2) or Acinetobacter baumannii (OR 0.9; 95% CI 0.5e1.5). Conclusion: Host environmentsdnursing home or hospital exposuredwere shown to be more significant than medical comorbid conditions for acquiring antimicrobial-resistant pathogens. Each unique environment increased the risk for acquiring some pathogens, but not all. In addition, these environmental factors may also exert cumulative effects toward some specific pathogens.

Prevalence and risk factors for bloodstream infection present on hospital admission

“…Even when accounting for age, patients who were admitted from NHs were significantly more likely to have a BSI-POA than patients who were admitted from private homes or other hospitals. Consistent with our findings, other investigators examined BSI among NH and non-NH residents and established that NH exposure was a risk factor for BSI-POA caused by gram-positive and gram-negative organisms (Huang et al, 2012) and another study reported that residence in a long-term care facility was associated with gram-negative BSI-POA (Pop-Vicas et al, 2009). Limitations of these studies included the fact that patients were from a single hospital.…”

“…other hospital, nursing home [NH], private home), an important factor that can inform interventions. Further, many studies on BSI-POA have been limited to specific organisms (Courjon et al, 2015; Wang et al, 2015), single institutions (Akoua-Koffi et al, 2015; Artero et al, 2010), elderly (Huang et al, 2012) or intensive care units (Artero et al, 2010).…”

Nursing home-associated bloodstream infection: A scoping review

“…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. [10][11][12][13] Studies that evaluated exclusively NHABSI Table 1 summarizes the characteristics and findings of the 2 studies in which only NHABSI was evaluated.…”

“…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. [10][11][12][13] Studies that evaluated exclusively NHABSI Table 1 summarizes the characteristics and findings of the 2 studies in which only NHABSI was evaluated. The study by Almog et al 8 was a letter to the editor and was included in this review because it evaluated a large number of cases of NHABSI (N = 177) and provided information on antibiotic resistance.…”

“…Overall, 4 studies were identified that compared NHABSI with community-or hospital-associated BSI (Table 2). [10][11][12][13] The study population of the 4 studies differed: 2 studies included all episodes of BSI (community-, hospital-, and nursing home-associated) 10,12 ; 1 study focused on those aged ≥ 65 years with community-BSI, hospital-BSI, and NHABSI 11 ; and 1 study focused on those aged ≥65 years with community-onset BSI and NHABSI from a urinary tract source. 13 Only 1 study had a large sample size of NHABSI (N = 252 episodes); 11 in the other 3 studies, the number of episodes ranged from 57 to 77.…”