Nosocomial infection and antibiotic utilization in geriatric patients: a pilot prospective surveillance program in skilled nursing facilities

• Published in: Gerontology (Basel) Vol. 38; no. 4; p. 223
• Main Authors: Lee, Y L, Thrupp, L D, Friis, R H, Fine, M, Maleki, P, Cesario, T C
• Format: Journal Article
• Language: English
• Published: Switzerland 1992
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Bacterial Infections - drug therapy; Bacterial Infections - epidemiology; California - epidemiology; Cross Infection - drug therapy; Cross Infection - epidemiology; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Pilot Projects; Prospective Studies; Quality of Health Care; Skilled Nursing Facilities - statistics & numerical data; California
• ISSN: 0304-324X
• DOI: 10.1159/000213332

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.