Risk factors for the development of bacteremia in nursing home patients
J. P. Richardson and L. Hricz
Department of Family Medicine, University of Maryland School of Medicine, Baltimore, USA.
BACKGROUND: While bacteremia has been studied in hospitalized elderly,
there have been few studies in nursing home patients. We hypothesized that
the presence of functional impairment would be associated with the
development of bacteremia. OBJECTIVE: To determine risk factors for
bacteremia in nursing home patients. DESIGN: Case-control study. Admission
characteristics of cases and controls were compared. For cases,
characteristics of the illness, mortality rates, origin of bacteremia, and
organisms were recorded. SETTING: A 320-bed long-term care hospital and
nursing home. SUBJECTS: Cases were patients with at least one blood culture
positive for pathogenic organisms. The next patient admitted after the
admission date of a case entered the control group. MAIN OUTCOME MEASURE:
Admission characteristics of patients associated with the development of
bacteremia. Clinical characteristics of cases and admitting characteristics
associated with death caused by bacteremia were also determined. RESULTS:
Twenty-six cases were identified, for an incidence of 0.24 per 1000
patient-days. There were significant associations between the development
of bacteremia and the presence of a urinary catheter (P = .002 by chi 2
analysis) or urinary incontinence (P = .01 by chi 2 analysis). Men (P =
.09) and patients with tracheostomies (P = .08 by chi 2 analysis) were
somewhat more likely to develop bacteremia, but these associations were not
statistically significant. The only admission characteristic of cases that
was associated with death caused by bacteremia was hypocholesterolemia
(3.79 mmol/L [147 mg/dL] in patients who died vs 5.05 mmol/L [195 mg/dL] in
patients who survived, P = .03 by t test). CONCLUSIONS: Nursing home
patients with urinary incontinence or a urinary catheter are at increased
risk of bacteremia.
