Multidrug-Resistant Blood Stream Infections Common in NH Residents Hospitalized for Sepsis

Nearly half of nursing home residents admitted to an acute care hospital with a sepsis diagnosis had multidrug-resistant blood stream infections, according to a study results published online ahead of print in the Journal of Intensive Care Medicine.

“Nursing home residents have a high prevalence of multidrug-resistant blood stream infection, which is associated with higher risk of receiving inappropriate initial anti-infective therapy, higher cost, higher intensive care unit length of stay, and higher mortality,” wrote researchers from MedStar Washington Hospital Center in Washington, DC.

The retrospective study investigated the prevalence of multidrug-resistant blood stream infections and non-multidrug-resistant blood stream infections among adults diagnosed with sepsis and admitted from skilled nursing facilities to the 960-bed tertiary academic medical center between 2015 and 2018.

Among the study population, 47% had multidrug-resistant blood stream infections, researchers found.

Half the blood stream infections were gram-positive, 45% were gram-negative, and 5% were fungal, according to the study. Multidrug-resistant organisms accounted for 57% of the gram-positive infections and 30% of the gram-negative infections. Staphylococcus aureus was present in 24%, Escherichia coli in 14%, Proteus mirabilis in 13%, Staphylococcus epidermidis in 8%, Enterococcus faecalis in 7%, and Klebsiella pneumoniae in 6%.

Multidrug-resistant blood stream infections were associated with significantly longer length of stay in intensive care (7 days vs 5 days) as well as higher direct costs ($13,639 vs $9922) and total costs ($23,752 vs $17,900) compared with non-multidrug-resistant blood stream infections.

Additionally, patients with multidrug-resistant blood stream infections were twice as likely to receive inappropriate empiric anti-infective therapy. They were also more likely to die: The study reported a 49.1% mortality rate compared with 29.6% for non-multidrug-resistant blood stream infections.

—Jolynn Tumolo

Reference:

Aliyu S, McGowan K, Hussain D, Kanawati L, Ruiz M, Yohannes S. Prevalence and Outcomes of Multi-Drug Resistant Blood Stream Infections Among Nursing Home Residents Admitted to an Acute Care Hospital [published online ahead of print, 2021 May 3]. J Intensive Care Med. 2021;8850666211014450. doi:10.1177/08850666211014450