Bacteremia in a long term care facility

Area of Science:

• Infectious Diseases
• Epidemiology
• Geriatric Medicine

Background:

• Bacteremia (bacteria in the bloodstream) is a serious concern in long-term care facilities (LTCFs).
• Understanding the incidence, causative organisms, and outcomes of bacteremia is crucial for infection control in this vulnerable population.

Purpose of the Study:

• To analyze episodes of bacteremia in an LTCF over a 7.5-year period.
• To determine the common pathogens, sources, and case fatality rates associated with bacteremia in this setting.
• To compare findings with previously reported rates from other North American LTCFs.

Main Methods:

• Retrospective review of 29 bacteremia episodes from July 1984 to December 1991.
• Identification of infecting organisms, primary sources of infection, and patient outcomes.
• Calculation of bacteremia incidence rate per 100,000 patient-days.

Main Results:

• An overall bacteremia rate of 4.35/100,000 patient-days was observed.
• Escherichia coli was the most frequent pathogen (11 episodes), followed by Streptococcus pneumoniae (4), Proteus mirabilis (3), Staphylococcus aureus (3), and Bacteroides species (2).
• The urinary tract was the most common source (45%), followed by gastrointestinal (17%), pneumonia (14%), and skin (14%).
• The overall case fatality rate was 24%, significantly decreasing to 9.5% in the final six years of the study.
• The observed bacteremia rate was approximately 10-fold lower than reported in other North American LTCFs.

Conclusions:

• The study identified a lower incidence of bacteremia and a potentially reduced case fatality rate in this LTCF compared to other facilities.
• The urinary tract remains the primary site for bacteremia in long-term care settings.
• These findings highlight the importance of targeted infection control strategies, particularly for urinary tract infections, in LTCFs.