title: Clinical correlates of bacteremia in a Veterans Administration extended care facility.
abstract: Little is known about bacteremia in long-term care facilities. We have conducted a retrospective study during a 12-month period analyzing the clinical correlates of bacteremia in 533 chronically institutionalized, predominantly male patients, with an average age of 69 years. Thirty-four men had forty-two bacteremic illnesses during this period. The incidence rate was 0.30 episodes per 1000 patient care days, and the mortality rate was 21%. The urinary tract was the most frequently identified tissue source (56%), followed by respiratory tract (7%) and skin (7%). Providencia stuartii was the most common gram-negative organism, while Staphylococcus aureus, Streptococcus pneumoniae and enterococcus were the frequent gram-positive microbes. Gram-negative bacteremia accounted for 63% of the episodes (15% mortality rate), and gram-positive bacteremia accounted for 27% (18% mortality rate); 10% of the bacteremias were polymicrobial (25% mortality rate). Most of the isolated organisms were sensitive to available antimicrobial agents. The leading risk factor for bacteremia was an indwelling urinary catheter (odds ratio 39, 95% confidence limits 16 to 97). Patients with urinary catheters at the beginning of the study constituted only 5% of the population, but accounted for 40% of the gram-negative bacteremias during the year of observation.
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006090:Gram-Negative Bacteria; D006094:Gram-Positive Bacteria; D006801:Humans; D007326:Institutionalization; D007441:Intubation, Gastrointestinal / Q000009:adverse effects; D008297:Male; D008826:Microbial Sensitivity Tests; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D012866:Skilled Nursing Facilities; D014481:United States; D014493:United States Department of Veterans Affairs; D014546:Urinary Catheterization / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000150:complications / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents