Risk factors for the development of bacteremia in nursing home patients.

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.