Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-24T21:55:22.140Z Has data issue: false hasContentIssue false
  • English
  • Français

Nursing home-associated bloodstream infection: A scoping review

Published online by Cambridge University Press:  02 March 2022

Joseph M. Mylotte Open the ORCID record for Joseph M. Mylotte [Opens in a new window]
Joseph M. Mylotte*
Affiliation:
Professor Emeritus of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
*
Author for correspondence: Joseph M. Mylotte, E-mail: jmm702@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To update a 2005 review of nursing home–associated bloodstream infection (NHABSI) regarding sources, organisms, antibiotic resistance, and outcome.

Methods:

A scoping review of studies of NHABSI identified by searching Google Scholar and Medline with OVID for the period January 1, 2004, to June 30, 2021, was conducted.

Results:

Overall, 6 studies of NHABSI were identified. Only 1 study was conducted with residents in North American facilities whereas in the 2005 review all studies were conducted in North America. Escherichia coli was the most common blood isolate, the urinary tract was the most common source of NHABSI; and the case-fatality rates ranged from 21% to 28%. These findings were comparable to those in the 2005 review. However, the proportion of NHABSI episodes due to antibiotic-resistant organisms increased substantially compared to the 2005 review. The most common antibiotic-resistant organisms were extended-spectrum β-lactamase–producing E. coli and Klebsiella spp. The 2 studies that evaluated the relationship between appropriate empiric antibiotic therapy and outcome came to different conclusions.

Conclusions:

The only major difference between the 2 reviews in the epidemiology of NHABSI was the marked increase in antibiotic resistance among blood isolates. Despite the increased antibiotic resistance, the case fatality rates in the current review were comparable to those reported in the 2005 review. However, the impact of appropriate empiric antibiotic therapy on outcome of NHABSI remains unclear.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 1 , January 2023 , pp. 82 - 87
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Mylotte, JM. Nursing home-acquired bloodstream infection. Infect Control Hosp Epidemiol 2005;26:833–837.Google ScholarPubMed
Setia, U, Serventi, I, Lorenz, P. Bacteremia in a long-term care facility: spectrum and mortality. Arch Intern Med 1984;144:1633–1635.Google Scholar
Rudman, D, Hontanosas, A, Cohen, Z, Mattson, DE. Clinical correlates of bacteremia in a Veterans’ Administration extended care facility. J Am Geriatr Soc 1988;36:726–732.CrossRefGoogle Scholar
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;14:647–654.CrossRefGoogle Scholar
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;35:1484–1490.CrossRefGoogle Scholar
Nicolle, LE, McIntyre, M, Hoban, D, Murray, D. Bacteremia in a long-term care facility. Can J Infect Dis 1994;5:130–132.Google Scholar
Khayr, WF, CarMichael MJ, Dubanowich CS, Latif RH, Waiters L. Bacteremia in Veterans’ Administration nursing home patients. Am J Ther 2004;11:251–525.CrossRefGoogle ScholarPubMed
Almog, M, Yanovskay, A, Edelstein, H, Schwartz, N, Colodner, R, Chazan, B. Increasing antimicrobial resistance in long-term care facility patients with bacteremia: a 5-year surveillance. J Am Med Dir Assoc 2018;19:1024–1026.CrossRefGoogle Scholar
Aliyu, S, McGowan, K, Hussain, D, Kanawati, L, Ruiz, M, Yohannes, S. Letter to the Editor: Prevalence and outcomes of multidrug-resistant blood stream infections among nursing home residents admitted to an acute care hospital. J Intensive Care Med 2021. doi: 10.1177/08850666211014450.CrossRefGoogle Scholar
Chazan, B, Raz, R, Teitler, N, Nitzan, O, Edelstein, H, Colodner, R. Epidemiology and susceptibility to antimicrobials in community, hospital and long-term care facility bacteremia in northern Israel: a 6-year surveillance. Israel Med Assoc J 2009;11:592–597.Google Scholar
Huang, MY, Chang, WH, Hsu, CY, et al. Bloodstream infections in the elderly: effects of nursing homes on antimicrobial-resistant bacteria. Int J Gerontol 2012;6:93–100.CrossRefGoogle Scholar
Yang, CJ, Chung, YC, Chen, TC, et al. The impact of inappropriate antibiotics on bacteremia patients in a community hospital in Taiwan: an emphasis on the impact of referral information for cases from a hospital affiliated nursing home. BMC Infect Dis 2013;13:1–8.CrossRefGoogle Scholar
Gómez Belda, AB, De la Fuente, J, Diez, LF, et al. Inadequate empirical antimicrobial treatment in older people with bacteremic urinary tract infection who reside in nursing homes: a multicenter prospective observational study. Geriatr Gerontol Int 2019;19:1112–1117.CrossRefGoogle ScholarPubMed
Magiorakos, AP, Srinivasan, A, Carey, RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268–281.Google ScholarPubMed
O’Fallon, E, Pop-Vicas, A, D’Agata, E. The emerging threat of multidrug-resistant gram-negative organisms in long-term care facilities. J Gerontol A Biomed Sci Med Sci 2009;64:138–141.CrossRefGoogle ScholarPubMed
van Buul, LW, van der Steen, JT, Veenhuizen, RB, et al. Antibiotic use and resistance in long-term care facilities. J Am Med Dir Assoc 2012;13:568.e158-e13.CrossRefGoogle ScholarPubMed
Aliyu, S, Smaldone, A, Larson, E. Prevalence of multidrug-resistant gram-negative bacteria among nursing home residents: a systematic review and meta-analysis. Am J Infect Control 2017;45:512–518.CrossRefGoogle ScholarPubMed
High, KP, Bradley, SF, Gravenstein, S, et al. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis 2009;48:149–171.CrossRefGoogle ScholarPubMed
Mylotte, JM. What is the role of nursing homes in the Surviving Sepsis Campaign? J Am Med Dir Assoc 2020;21:41–45.CrossRefGoogle ScholarPubMed
Mylotte, JM. Models for assessing severity of illness in patients with bloodstream infection: a narrative review. Curr Treat Options Infec Dis 2021;13:153–164.CrossRefGoogle Scholar
Crnich, CJ, Drinka, P. Medical device-associated infection in the long-term care setting. Infect Dis Clin N Am 2012;26:143–164.CrossRefGoogle ScholarPubMed