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Nosocomial infection and antibiotic utilization in geriatric patients: a pilot prospective surveillance program in
Y L Lee1, L D Thrupp, R H Friis
1Department of Medicine, University of California, Irvine 92717.
Abstract:
Prospective surveillance of nosocomial infection was conducted at seven skilled proprietary nursing facilities in Orange County, Calif., USA. The average incidence of facility-acquired infection was 5.2 infections/1,000 patient days. The most common source of infection was urinary tract (47%), followed by respiratory tract (26%) and skin (14%). The four most common pathogens isolated were Proteus spp. (20%), Escherichia coli (17%), Staphylococcus aureus (13%) and Pseudomonas spp. (11%). Trimethoprim-sulfamethoxazole (20%) was the most frequently used antibiotic among all prescriptions, followed by ampicillin (16%) and ciprofloxacin (14%). Among all residents surveyed, 33% received at least one course of antibiotics during the study. Of special significance was the fact that 4 (22%) of the 18 strains of Pseudomonas were gentamicin resistant as were 12 of 80 (15%) of the strains of Enterobacteriaceae. Furthermore, 9 of 29 (31%) strains of Pseudomonas tested were found resistant to norfloxacin as were 15 of 129 (12%) strains of enterobacteriaceae. Susceptibility patterns of the isolated pathogens were similar to those of the acute care hospital. This study indicates that infection continues to be a major problem in the skilled nursing facility and that antibiotic-resistant pathogens will be a challenge for the future.
Insights
Nosocomial infections are common in skilled nursing facilities, with urinary tract infections being most frequent. Antibiotic-resistant pathogens pose a significant future challenge in these settings.
Area of Science:
- Infectious Diseases
- Healthcare Epidemiology
- Antimicrobial Resistance
Background:
- Nosocomial infections are a significant concern in healthcare settings.
- Skilled nursing facilities (SNFs) care for vulnerable populations susceptible to infections.
Purpose of the Study:
- To prospectively surveil nosocomial infections in SNFs.
- To identify common infection sources, pathogens, and antibiotic resistance patterns.
Main Methods:
- Prospective surveillance conducted across seven skilled nursing facilities.
- Data collection on infection incidence, sources, pathogens, and antibiotic susceptibility.
Main Results:
- Average facility-acquired infection rate was 5.2 per 1,000 patient days.
- Urinary tract infections (47%) were the most common source, followed by respiratory (26%).
- High rates of resistance observed, including gentamicin-resistant Pseudomonas (22%) and norfloxacin-resistant Pseudomonas (31%).
Conclusions:
- Infections remain a major problem in skilled nursing facilities.
- Antibiotic-resistant pathogens present a growing challenge for patient care in SNFs.
- Susceptibility patterns in SNFs mirror those in acute care hospitals.