Residents from long-term care facilities (LTCF) hospitalized with an acute infectious disease are challenging in terms of diagnosis and treatment , considering atypical clinical presentation are high rate of resistant bacteria, .
This study aimed to Characterize patients with LTCF acquired bacteremia (LTCF-B), epidemiology of blood cultures (BC) and potential risk for mortality.
A retrospective study of LTCF residents hospitalized with LTCF-B. Demographic, clinical and laboratory data were collected and analyzed using SPSS 22 and SAS.
177 LTCF residents hospitalized in internal wards were included, mean age 81.6yrs, mostly completely dependent, 54.8% were males. Most frequent diagnoses was urinary tract infection (UTI), second by respiratory tract infections. Half were hospitalized during prior 6 months, 1/3 had a permanent indwelling urinary catheter. On admission, 70% had WBC blood count >10,000cells/ml. The following pathogens were isolated from BC: gram-negative enterobacteriaceae (70%): E.coli were 40% and gram-positive cocci (21%): S.aureus 5.08% (55.5% of them MRSA). Extended-spectrum-beta-lactamase (ESBL) producing enterobacteriaceae were in 47.1% BC, clearly document increase during the years, 26% (2010) - 63% (2014). Absolute majority of enterobacteriaceae were sensitive to carbapenems and amikacin, half were resistant to gentamycin, 2nd & 3rd generation cephalosporins and quinolones.
Inappropriate empiric antimicrobial therapy was given to 46.8% of patients with ESBL-producing enterobacteriaceae (p<0.001). Mortality rates were 21.5% in-hospital and 46.3% day-90 post discharge. Variables associated with mortality: initial diagnosis of skin and soft tissue infections (SSTI) (OR=14.44), inappropriate empiric antibiotic (OR=5.038), high level of urea (OR=1.017), and nasogastric tube (OR=4.966). UTI (OR=0.316) was a protective factor.
Diagnosis of SSTI, high urea levels, nasogastric tube, and inappropriate empiric antibiotic were associated with in-hospital mortality. The notable increased rate of ESBL-producing enterobacteriaceae should alert physicians to be aware of local microbial resistance profile, especially among LTCFs patients.
H. Edelstein, None
R. Colodner, None
N. Schwartz, None
B. Chazan, None