Acute gastroenteritis in three community-based nursing homes.
BACKGROUND
Acute gastroenteritis is a cause of considerable morbidity and mortality in the elderly population. A prospective assessment of acute diarrhea in three community-based long-stay homes is described.


METHODS
A cohort study of acute gastroenteritis was performed in three community-based nursing homes, involving 572 residents over an 8-month period. Diarrhea cases were enrolled on the basis of the acute onset of loose stools of > or = 24 hours, as well as one of the following: a rectal temperature of > or = 100 degrees F, dehydration, positive occult blood, > or = 48 hours duration, or as a part of any outbreak. Stool cultures for Clostridium difficile were performed on all NH 1 patients.


RESULTS
Fifty-three gastroenteritis cases were ascertained, consistent with incidence rates of 14.6, 36.4, and 6.7 cases/100 patient years in NH 1, NH 2, and NH 3, respectively. Requiring a Foley catheter (OR = 2.57; 95% CI, 0.93, 7.09) increased diarrhea risk. Six Clostridium difficile enteritis cases and an episode attributable to Aeromonas/Pleisomonas species were diagnosed. One C. difficile diarrhea case was imported from hospital to NH 1. Ten of 12 fecal excretors resided in close geographic clusters in NH 1, where a majority of the latter were mobile and incontinent of stool.


CONCLUSIONS
Acute gastroenteritis was a common disease in the study nursing homes, for which specific risk factors were identified. A predominant role for Clostridium difficile in the taxonomy of nursing home diarrhea was suggested.
Sims
R V
RV
Geriatrics Division, Philadelphia VA Medical Center, Pennsylvania, USA.
Hauser
R J
RJ
Adewale
A O
AO
Maislin
G
G
Skeie
S
S
Lavizzo-Mourey
R J
RJ
Rubin
H
H
D000208:Acute Disease; D000368:Aged; D016360:Clostridioides difficile; D015331:Cohort Studies; D003153:Community Health Services; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening; D009735:Nursing Homes; D010414:Pennsylvania / Q000453:epidemiology; D011446:Prospective Studies