Antibiotic-resistant flora in nursing home patients admitted to the hospital

To study carriage of multiply resistant gram-negative bacilli, 50 patients admitted to the hospital from nursing homes (NHs) and 50 control admissions not from NHs were matched for age and recent antibiotic use. Their antibiotic resistance patterns were similar: 20 NH patients and 14 controls had resistant strains. However, significantly more patients (64%) from NHs with large numbers of "skilled beds" had resistant bacteria than did patients from small NHs (21%) or controls (28%). Also, more patients from NHs had members of the Proteus-Providencia-Morganella group in their urine than did controls. Discriminant analysis showed that residence in NHs with large numbers of skilled beds, recent antibiotic use, and bladder dysfunction (indwelling catheter or incontinence) were independently important in predicting carriage of resistant strains in NH and control patients. Over 75% of resistant isolates were from rectal specimens, emphasizing the occult way that such strains are brought into the hospital.