Magaziner J, Tenney J H, DeForge B, Hebel J R, Muncie H L, Warren J W
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore.
J Am Geriatr Soc. 1991 Nov;39(11):1071-8. doi: 10.1111/j.1532-5415.1991.tb02871.x.
This study provides estimates of the prevalence of infections in all patients from a representative sample of 53 Maryland nursing homes; identifies risk factors for these infections; and describes diagnostic procedures carried out.
The records of 4,259 patients in a stratified random sample of 53 Maryland nursing homes were reviewed for diagnostic procedures, medical, functional, and behavioral status. Infections were identified by signs, symptoms, and laboratory findings.
Study patients were characteristic of aged patients in US nursing homes. The prevalence of infections actually acquired in the nursing home (80% of all infections) was 4.4%. Multivariate analysis revealed that skin infections (35% of nursing home-acquired infections) were associated with skin ulcers and inversely with urine incontinence. Fevers of uncertain source (13%) were associated with bladder catheters. Symptomatic urinary infections (12%) and lower respiratory infections (12%) were associated with bedfast status, and the latter with tracheostomy and lung disease. Skin ulcers, urethral catheters, and bedfast status were markers for nursing home-acquired infection. The prevalence of infection in patients with all three markers was 32%; in patients with none, 2%. Fewer than a quarter of the four most common nursing home-acquired infections received an evaluation which met minimal diagnostic criteria established by a panel of infectious disease specialists and geriatricians. Patients with dementia, those in large homes (greater than 150 beds), and those in urban homes were less likely to be evaluated in a manner meeting these criteria.
Use of three characteristics (ie skin ulcers, urethral catheters, bedfast status) to identify patients at risk for nursing home-acquired infections may allow targeted infection surveillance and prevention programs. In addition, nursing home-acquired infections are not evaluated uniformly across patients and facilities, suggesting the need to establish, through further study, guidelines for such evaluations.
本研究对来自马里兰州53家具有代表性的疗养院的所有患者的感染患病率进行了估计；确定了这些感染的危险因素；并描述了所开展的诊断程序。
对马里兰州53家疗养院分层随机抽样的4259例患者的记录进行了审查，以了解诊断程序、医疗、功能和行为状况。通过体征、症状和实验室检查结果来确定感染情况。
研究患者具有美国疗养院老年患者的特征。在疗养院实际发生的感染（占所有感染的80%）患病率为4.4%。多变量分析显示，皮肤感染（占疗养院获得性感染的35%）与皮肤溃疡有关，与尿失禁呈负相关。不明原因发热（13%）与膀胱导管有关。有症状的泌尿系统感染（12%）和下呼吸道感染（12%）与卧床状态有关，后者与气管切开术和肺部疾病有关。皮肤溃疡、尿道导管和卧床状态是疗养院获得性感染的标志。具有所有这三个标志的患者感染患病率为32%；没有这些标志的患者为2%。四种最常见的疗养院获得性感染中，接受符合传染病专家和老年病专家小组制定的最低诊断标准评估的不到四分之一。患有痴呆症的患者、大型疗养院（超过150张床位）的患者和城市疗养院的患者接受符合这些标准评估的可能性较小。
使用三个特征（即皮肤溃疡、尿道导管、卧床状态）来识别有疗养院获得性感染风险的患者，可能有助于开展有针对性的感染监测和预防计划。此外，不同患者和机构对疗养院获得性感染的评估并不统一，这表明需要通过进一步研究制定此类评估的指南。
