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Antibiotic-Resistant Flora in Nursing Home Patients Admitted to the Hospital

Antibiotic-Resistant Flora in Nursing Home Patients Admitted to the Hospital Abstract • To study carriage of multiply resistant gram-negative bacilli, 50 patients admitted to the hospital from nursing homes (NHs) and 50 control admissions not from NHs were matched for age and recent antibiotic use. Their antibiotic resistance patterns were similar: 20 NH patients and 14 controls had resistant strains. However, significantly more patients (64%) from NHs with large numbers of "skilled beds" had resistant bacteria than did patients from small NHs (21%) or controls (28%). Also, more patients from NHs had members of the Proteus-Providencia-Morganella group in their urine than did controls. Discriminant analysis showed that residence in NHs with large numbers of skilled beds, recent antibiotic use, and bladder dysfunction (indwelling catheter or incontinence) were independently important in predicting carriage of resistant strains in NH and control patients. Over 75% of resistant isolates were from rectal specimens, emphasizing the occult way that such strains are brought into the hospital. (Arch Intern Med 1985;145:1804-1807) References 1. Garibaldi RA, Brodine S, Matsumiya S: Infections among patients in nursing homes. N Engl J Med 1981;305:731-735.Crossref 2. Weinstein RA, Nathan C, Gruensfelder R, et al: Endemic aminoglycoside resistance in gram-negative bacilli: Epidemiology and mechanisms. J Infect Dis 1980;141:338-345.Crossref 3. Weinstein RA, Kabins SA: Strategies for prevention and control of multiple-drug resistant nosocomial infections. Am J Med 1981;70:449-454. 4. Magnussen MH, Robb SS: Nosocomial infections in a long-term care facility. Am J Infect Control 1980;8:12-17.Crossref 5. Health Care Financing Notes: Medicare: Use of Skilled Nursing Facilities 1976-1977 , Dept of Health, Education, and Welfare publication (HCFA) 77-10961, 1977. 6. Ballows A, Hausler WJ (eds): Diagnostic Procedures for Bacterial, Mycotic, and Parasitic Infections . Washington, DC, American Public Health Association Inc, 1981. 7. MacLowry JD, Robertson EA, Friedman RB, et al: Antimicrobial susceptibilities of commonly encountered aerobic and facultative anaerobic bacteria , in Seligson D (ed): CRC Handbook Series in Clinical Laboratory Science. Section E: Clinical Microbiology , vol 2; Von Graevonitz A (section ed). Cleveland, CRC Press Inc, 1977, pp 253-280. 8. Nie NH, Bent DH, Hull CH: Statistical Package for the Social Sciences , ed 2. New York, McGraw Hill Book Co, 1975. 9. Schneider EL: Infectious diseases in the elderly. Ann Intern Med 1983;98:395-400.Crossref 10. Garb JL, Brown RB, Garb JR, et al: Differences in etiology of pneumonias in nursing home and community patients. JAMA 1978;240: 2169-2172.Crossref 11. Alling B, Brandberg A, Seeberg S, et al: Aerobic and anaerobic microbial flora in the urinary tract of geriatric patients during long-term care. J Infect Dis 1973;127:34-39.Crossref 12. Warren JW, Tenney JH, Hoopes JM, et al: A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis 1982;146:719-723.Crossref 13. Galpin JE, Chow AW, Bayer AS, et al: Sepsis associated with decubitus ulcers. Am J Med 1976;61:346-350.Crossref 14. Checko PJ: A Study of Infection Control Programs in Skilled Nursing Facilities in Connecticut: Suggested Alternatives for Surveillance and Criteria of Infection, thesis. Yale University, New Haven, Conn, 1981. 15. Guttmann L, Frankel H: The value of intermittent catheterization in early management of traumatic paraplegia and tetraplegia. Paraplegia 1966;4:63-83.Crossref 16. Selden R, Lee S, Wang WLL, et al: Nosocomial Klebsiella infections: Intestinal colonization as a reservoir. Ann Intern Med 1971;74:657-664.Crossref 17. Valenti WM, Trudell RG, Bentley DW: Factors predisposing to oropharyngeal colonization with gram-negative bacilli in the aged. N Engl J Med 1978;298:1108-1111.Crossref 18. Gaynes RP, Weinstein RA, Smith J, et al: Control of aminoglycoside resistance by barrier precautions. Infect Control 1983;4:221-224. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Antibiotic-Resistant Flora in Nursing Home Patients Admitted to the Hospital

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References (19)

Publisher
American Medical Association
Copyright
Copyright © 1985 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1985.00360100064009
Publisher site
See Article on Publisher Site

Abstract

Abstract • To study carriage of multiply resistant gram-negative bacilli, 50 patients admitted to the hospital from nursing homes (NHs) and 50 control admissions not from NHs were matched for age and recent antibiotic use. Their antibiotic resistance patterns were similar: 20 NH patients and 14 controls had resistant strains. However, significantly more patients (64%) from NHs with large numbers of "skilled beds" had resistant bacteria than did patients from small NHs (21%) or controls (28%). Also, more patients from NHs had members of the Proteus-Providencia-Morganella group in their urine than did controls. Discriminant analysis showed that residence in NHs with large numbers of skilled beds, recent antibiotic use, and bladder dysfunction (indwelling catheter or incontinence) were independently important in predicting carriage of resistant strains in NH and control patients. Over 75% of resistant isolates were from rectal specimens, emphasizing the occult way that such strains are brought into the hospital. (Arch Intern Med 1985;145:1804-1807) References 1. Garibaldi RA, Brodine S, Matsumiya S: Infections among patients in nursing homes. N Engl J Med 1981;305:731-735.Crossref 2. Weinstein RA, Nathan C, Gruensfelder R, et al: Endemic aminoglycoside resistance in gram-negative bacilli: Epidemiology and mechanisms. J Infect Dis 1980;141:338-345.Crossref 3. Weinstein RA, Kabins SA: Strategies for prevention and control of multiple-drug resistant nosocomial infections. Am J Med 1981;70:449-454. 4. Magnussen MH, Robb SS: Nosocomial infections in a long-term care facility. Am J Infect Control 1980;8:12-17.Crossref 5. Health Care Financing Notes: Medicare: Use of Skilled Nursing Facilities 1976-1977 , Dept of Health, Education, and Welfare publication (HCFA) 77-10961, 1977. 6. Ballows A, Hausler WJ (eds): Diagnostic Procedures for Bacterial, Mycotic, and Parasitic Infections . Washington, DC, American Public Health Association Inc, 1981. 7. MacLowry JD, Robertson EA, Friedman RB, et al: Antimicrobial susceptibilities of commonly encountered aerobic and facultative anaerobic bacteria , in Seligson D (ed): CRC Handbook Series in Clinical Laboratory Science. Section E: Clinical Microbiology , vol 2; Von Graevonitz A (section ed). Cleveland, CRC Press Inc, 1977, pp 253-280. 8. Nie NH, Bent DH, Hull CH: Statistical Package for the Social Sciences , ed 2. New York, McGraw Hill Book Co, 1975. 9. Schneider EL: Infectious diseases in the elderly. Ann Intern Med 1983;98:395-400.Crossref 10. Garb JL, Brown RB, Garb JR, et al: Differences in etiology of pneumonias in nursing home and community patients. JAMA 1978;240: 2169-2172.Crossref 11. Alling B, Brandberg A, Seeberg S, et al: Aerobic and anaerobic microbial flora in the urinary tract of geriatric patients during long-term care. J Infect Dis 1973;127:34-39.Crossref 12. Warren JW, Tenney JH, Hoopes JM, et al: A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis 1982;146:719-723.Crossref 13. Galpin JE, Chow AW, Bayer AS, et al: Sepsis associated with decubitus ulcers. Am J Med 1976;61:346-350.Crossref 14. Checko PJ: A Study of Infection Control Programs in Skilled Nursing Facilities in Connecticut: Suggested Alternatives for Surveillance and Criteria of Infection, thesis. Yale University, New Haven, Conn, 1981. 15. Guttmann L, Frankel H: The value of intermittent catheterization in early management of traumatic paraplegia and tetraplegia. Paraplegia 1966;4:63-83.Crossref 16. Selden R, Lee S, Wang WLL, et al: Nosocomial Klebsiella infections: Intestinal colonization as a reservoir. Ann Intern Med 1971;74:657-664.Crossref 17. Valenti WM, Trudell RG, Bentley DW: Factors predisposing to oropharyngeal colonization with gram-negative bacilli in the aged. N Engl J Med 1978;298:1108-1111.Crossref 18. Gaynes RP, Weinstein RA, Smith J, et al: Control of aminoglycoside resistance by barrier precautions. Infect Control 1983;4:221-224.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 1, 1985

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