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. 1998 Feb;44:317–322.

Bacteremia in nursing home patients. Prevalence among patients presenting to an emergency department.

D Sinclair 1, A Svendsen 1, T Marrie 1
PMCID: PMC2277607  PMID: 9512835

Abstract

OBJECTIVE: To measure the prevalence of bacteremia and any correlation between signs and symptoms, risk factors, and laboratory data in elderly patients. DESIGN: Prospective analysis. All patients were contacted by the study nurse at 48 hours and 7 days after study entry. SETTING: Adult tertiary care hospital with an emergency department managing 48,000 visits yearly in a metropolitan area of 250,000. PARTICIPANTS: Members of the study population referred to the emergency department for medical or surgical problems. Of 113 nursing home patients, blood culture results were available for 111. MAIN OUTCOME MEASURES: Blood cultures were obtained by standard protocol. Demographic and medical information was collected from the medical record. Three groups of patients were compared with respect to symptoms, risk factors, laboratory data, and outcome. RESULTS: Group 1 (n = 86) had two sets of negative blood cultures. Group 2 (n = 10) had true-positive cultures. Group 3 (n = 15) had false-positive cultures of Staphylococcus epidermidis. The prevalence of bacteremia was 9.8% in the study population. No risk factors were predictive of bacteremia. Great variation in signs and symptoms were noted in all three groups, none correlating with bacteremia. Although seven of the 10 patients with positive cultures were febrile, this association did not reach statistical significance. All groups had high admission (> 50%) and mortality (20% to 37%) rates. CONCLUSIONS: The prevalence of bacteremia in the nursing home population presenting to the emergency department was 9.8%. The symptoms and signs of bacteremia in this population were variable and nonspecific. The high rate of false-positive cultures in this setting is of concern.

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Selected References

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  1. Aronson M. D., Bor D. H. Blood cultures. Ann Intern Med. 1987 Feb;106(2):246–253. doi: 10.7326/0003-4819-106-2-246. [DOI] [PubMed] [Google Scholar]
  2. Bates D. W., Goldman L., Lee T. H. Contaminant blood cultures and resource utilization. The true consequences of false-positive results. JAMA. 1991 Jan 16;265(3):365–369. [PubMed] [Google Scholar]
  3. Bates D. W., Pruess K. E., Lee T. H. How bad are bacteremia and sepsis? Outcomes in a cohort with suspected bacteremia. Arch Intern Med. 1995 Mar 27;155(6):593–598. [PubMed] [Google Scholar]
  4. Berman P., Hogan D. B., Fox R. A. The atypical presentation of infection in old age. Age Ageing. 1987 Jul;16(4):201–207. doi: 10.1093/ageing/16.4.201. [DOI] [PubMed] [Google Scholar]
  5. Butler C., Rollnick S., Stott N. The practitioner, the patient and resistance to change: recent ideas on compliance. CMAJ. 1996 May 1;154(9):1357–1362. [PMC free article] [PubMed] [Google Scholar]
  6. Chalasani N. P., Valdecanas M. A., Gopal A. K., McGowan J. E., Jr, Jurado R. L. Clinical utility of blood cultures in adult patients with community-acquired pneumonia without defined underlying risks. Chest. 1995 Oct;108(4):932–936. doi: 10.1378/chest.108.4.932. [DOI] [PubMed] [Google Scholar]
  7. Chassagne P., Perol M. B., Doucet J., Trivalle C., Ménard J. F., Manchon N. D., Moynot Y., Humbert G., Bourreille J., Bercoff E. Is presentation of bacteremia in the elderly the same as in younger patients? Am J Med. 1996 Jan;100(1):65–70. doi: 10.1016/s0002-9343(96)90013-3. [DOI] [PubMed] [Google Scholar]
  8. Denham M. J., Goodwin G. S. The value of blood cultures in geriatric practice. Age Ageing. 1977 May;6(2):85–88. doi: 10.1093/ageing/6.2.85. [DOI] [PubMed] [Google Scholar]
  9. Finkelstein M. S., Petkun W. M., Freedman M. L., Antopol S. C. Pneumococcal bacteremia in adults: age-dependent differences in presentation and in outcome. J Am Geriatr Soc. 1983 Jan;31(1):19–27. doi: 10.1111/j.1532-5415.1983.tb06283.x. [DOI] [PubMed] [Google Scholar]
  10. Fontanarosa P. B., Kaeberlein F. J., Gerson L. W., Thomson R. B. Difficulty in predicting bacteremia in elderly emergency patients. Ann Emerg Med. 1992 Jul;21(7):842–848. doi: 10.1016/s0196-0644(05)81032-7. [DOI] [PubMed] [Google Scholar]
  11. Gleckman R., Hibert D. Afebrile bacteremia. A phenomenon in geriatric patients. JAMA. 1982 Sep 24;248(12):1478–1481. doi: 10.1001/jama.248.12.1478. [DOI] [PubMed] [Google Scholar]
  12. Gradman A. H. Hemodynamic effects of the vascular selective calcium antagonist felodipine in patients with impaired left ventricular function. Am Heart J. 1992 Jan;123(1):273–278. doi: 10.1016/0002-8703(92)90791-s. [DOI] [PubMed] [Google Scholar]
  13. Harris R. L., Musher D. M., Bloom K., Gathe J., Rice L., Sugarman B., Williams T. W., Jr, Young E. J. Manifestations of sepsis. Arch Intern Med. 1987 Nov;147(11):1895–1906. [PubMed] [Google Scholar]
  14. MacGregor R. R., Beaty H. N. Evaluation of positive blood cultures. Guidelines for early differentiation of contaminated from valid positive cultures. Arch Intern Med. 1972 Jul;130(1):84–87. [PubMed] [Google Scholar]
  15. McCue J. D. Gram-negative bacillary bacteremia in the elderly: incidence, ecology, etiology, and mortality. J Am Geriatr Soc. 1987 Mar;35(3):213–218. doi: 10.1111/j.1532-5415.1987.tb02311.x. [DOI] [PubMed] [Google Scholar]
  16. Nicolle L. E., McIntyre M., Zacharias H., MacDonell J. A. Twelve-month surveillance of infections in institutionalized elderly men. J Am Geriatr Soc. 1984 Jul;32(7):513–519. doi: 10.1111/j.1532-5415.1984.tb02236.x. [DOI] [PubMed] [Google Scholar]
  17. Richardson J. P., Hricz L. Risk factors for the development of bacteremia in nursing home patients. Arch Fam Med. 1995 Sep;4(9):785–789. doi: 10.1001/archfami.4.9.785. [DOI] [PubMed] [Google Scholar]
  18. Rudman D., Hontanosas A., Cohen Z., Mattson D. E. Clinical correlates of bacteremia in a Veterans Administration extended care facility. J Am Geriatr Soc. 1988 Aug;36(8):726–732. doi: 10.1111/j.1532-5415.1988.tb07175.x. [DOI] [PubMed] [Google Scholar]
  19. Setia U., Serventi I., Lorenz P. Bacteremia in a long-term care facility. Spectrum and mortality. Arch Intern Med. 1984 Aug;144(8):1633–1635. [PubMed] [Google Scholar]
  20. Weinstein M. P., Reller L. B., Murphy J. R., Lichtenstein K. A. The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. I. Laboratory and epidemiologic observations. Rev Infect Dis. 1983 Jan-Feb;5(1):35–53. doi: 10.1093/clinids/5.1.35. [DOI] [PubMed] [Google Scholar]
  21. Windsor A. C. Bacteraemia in a geriatric unit. Gerontology. 1983;29(2):125–130. doi: 10.1159/000213104. [DOI] [PubMed] [Google Scholar]

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