Abstract
Purpose
The aim of the study was to assess differences between elderly nursing home (NH) residents and elderly patients living in the community admitted to hospital for bacterial infection.
Methods
We conducted a prospective cohort study with manual data collection. Patients aged 65 years and older from NHs and from the community admitted to hospital for bacterial infection were included in the study. Patient characteristics, site of infection, microorganism profile, and final outcome were assessed and compared between these two subgroups of patients.
Results
Two hundred and sixty-two patients were from NHs and 707 were from the community. Patients from NHs were older, had more underlying chronic illnesses, and more often showed characteristics indicating advanced debility. In both groups, the most common site of infection was the respiratory tract. In comparison to the community group, patients from NHs had a higher fatality rate (23.3 vs. 10.9 %) and more often experienced functional decline at discharge (27.5 vs. 16.8 %). After adjustment for age, sex, presence of comorbidity, and debility, NH residence remained associated with increased in-hospital mortality but not with functional decline.
Conclusions
Elderly patients from NHs admitted to hospital for bacterial infection are older and more debilitated than their counterparts from the community. Microorganisms found in the NH residents are somewhat different from those in the community dwellers. The community dwellers had a better survival rate than those admitted from the NHs after adjusting for age, sex, presence of any comorbidity, and debility.
Similar content being viewed by others
References
High KP. Why should the infectious diseases community focus on aging and care of the older adult? Clin Infect Dis. 2003;37:196–200.
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. National nursing home survey. 2011. http://www.cdc.gov/nchs/nnhs.htm. Accessed 15 Nov 2012.
Vertot N. Prvi oktober, svetovni dan starejših. 2010. http://www.stat.si/novica_prikazi.aspx?id=2671. Accessed 10 Nov 2012.
Curns AT, Holman RC, Sejvar JJ, Owings MF, Schonberger LB. Infectious disease hospitalizations among older adults in the United States from 1990 through 2002. Arch Intern Med. 2005;165:2514–20.
Smith PW, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, Mody L, Nicolle L, Stevenson K; Society for Healthcare Epidemiology of America (SHEA); Association for Professionals in Infection Control and Epidemiology (APIC). SHEA/APIC Guideline: infection prevention and control in the long-term care facility. Am J Infect Control. 2008;36:504–35.
Nicolle LE. Infection control in long-term care facilities. Clin Infect Dis. 2000;31:752–6.
Yoshikawa TT, Norman DC. Infection control in long-term care. Clin Geriatr Med. 1995;11:467–80.
Quagliarello V, Ginter S, Han L, Van Ness P, Allore H, Tinetti M. Modifiable risk factors for nursing home-acquired pneumonia. Clin Infect Dis. 2005;40:1–6.
Garibaldi RA. Residential care and the elderly: the burden of infection. J Hosp Infect. 1999;43:S9–18.
Loeb MB, Craven S, McGeer AJ, Simor AE, Bradley SF, Low DE, Armstrong-Evans M, Moss LA, Walter SD. Risk factors for resistance to antimicrobial agents among nursing home residents. Am J Epidemiol. 2003;157:40–7.
Bonomo RA. Multiple antibiotic-resistant bacteria in long-term-care facilities: an emerging problem in the practice of infectious diseases. Clin Infect Dis. 2000;31:1414–22.
Yates M, Horan MA, Clague JE, Gonsalkorale M, Chadwick PR, Pendleton N. A study of infection in elderly nursing/residential home and community-based residents. J Hosp Infect. 1999;43:123–9.
Xie C, Taylor DM, Howden BP, Charles PG. Comparison of the bacterial isolates and antibiotic resistance patterns of elderly nursing home and general community patients. Intern Med J. 2012;42:e157–64.
Katz S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc. 1983;31:721–7.
Wojkowska-Mach J, Gryglewska B, Czekaj J, Adamski P, Grodzicki T, Heczko PB. Infection control: point prevalence study versus incidence study in Polish long-term care facilities in 2009–2010 in the Malopolska Region. Infection. 2013; 41:1–8.
Norman DC. Fever in the elderly. Clin Infect Dis. 2000;31:148–51.
Castle SC, Norman DC, Yeh M, Miller D, Yoshikawa TT. Fever response in elderly nursing home residents: are the older truly colder? J Am Geriatr Soc. 1991;39:853–7.
Rockwood K. Acute confusion in elderly medical patients. J Am Geriatr Soc. 1989;37:150–4.
Inouye SK. Delirium in older persons. N Engl J Med. 2006;354:1157–65.
Berman P, Hogan DB, Fox RA. The atypical presentation of infection in old age. Age Ageing. 1987;16:201–7.
Rummukainen ML, Karki T, Kanerva M, Haapasaari M, Ollgren J, Lyytikainen O. Antimicrobial prescribing in nursing homes in Finland: results of three point prevalence surveys. Infection. 2013;41:355–60.
Beck-Sague C, Banerjee S, Jarvis WR. Infectious diseases and mortality among US nursing home residents. Am J Public Health. 1993;83:1739–42.
Loeb M. Pneumonia in older persons. Clin Infect Dis. 2003;37:1335–9.
García-Garmendia JL, Ortiz-Leyba C, Garnacho-Montero J, Jiménez-Jiménez FJ, Pérez-Paredes C, Barrero-Almodóvar AE, Gili-Miner M. Risk factors for Acinetobacter baumannii nosocomial bacteremia in critically ill patients: a cohort study. Clin Infect Dis. 2001;33:939–46.
Venier AG, Gruson D, Lavigne T, Jarno P, L’hériteau F, Coignard B, Savey A, Rogues AM; REA-RAISIN group. Identifying new risk factors for Pseudomonas aeruginosa pneumonia in intensive care units: experience of the French national surveillance, REA-RAISIN. J Hosp Infect. 2011;79:44–8.
Bradley SF, Terpenning MS, Ramsey MA, Zarins LT, Jorgensen KA, Sottile WS, Schaberg DR, Kauffman CA. Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med. 1991;115:417–22.
Büla CJ, Ghilardi G, Wietlisbach V, Petignat C, Francioli P. Infections and functional impairment in nursing home residents: a reciprocal relationship. J Am Geriatr Soc. 2004;52:700–6.
High KP, Bradley S, Loeb M, Palmer R, Quagliarello V, Yoshikawa T. A new paradigm for clinical investigation of infectious syndromes in older adults: assessment of functional status as a risk factor and outcome measure. Clin Infect Dis. 2005;40:114–22.
Binder EF, Kruse RL, Sherman AK, Madsen R, Zweig SC, D′Agostino R, Mehr DR. Predictors of short-term functional decline in survivors of nursing home-acquired lower respiratory tract infection. J Gerontol A Biol Sci Med Sci. 2003;58:60–70.
Conflict of interest
On behalf of all authors, the corresponding author states that none of the authors have any conflict of interest with this paper.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Videcnik Zorman, J., Lusa, L., Strle, F. et al. Bacterial infection in elderly nursing home and community-based patients: a prospective cohort study. Infection 41, 909–916 (2013). https://doi.org/10.1007/s15010-013-0469-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s15010-013-0469-0