title: Nosocomial infection and antibiotic utilization in geriatric patients: a pilot prospective surveillance program in skilled nursing facilities.
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.
authors.affiliation: Department of Medicine, University of California, Irvine 92717.
authors.forename: Y L
authors.initials: YL
authors.lastname: Lee
authors.forename: L D
authors.initials: LD
authors.lastname: Thrupp
authors.forename: R H
authors.initials: RH
authors.lastname: Friis
authors.forename: M
authors.initials: M
authors.lastname: Fine
authors.forename: P
authors.initials: P
authors.lastname: Maleki
authors.forename: T C
authors.initials: TC
authors.lastname: Cesario
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology*; D002140:California / Q000453:epidemiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology*; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011787:Quality of Health Care; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*
chemical_list: D000900:Anti-Bacterial Agents