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Nursing home residents with obesity are at high risk for contracting urinary tract infections. In this research study, we found nursing homes in multi-facility chain organizations, for-profit status, nursing home size, obesity rate of resident population, and market competition were significantly associated with rates of urinary tract infections among residents with obesity. Keywords Activities of daily living, aging, bariatrics, urinary bladder, urinary catheters, urinary incontinence., 1.3 contact hours The urinary system includes the kidneys, ureters, bladder, and the urethra. Infections to any part of the urinary system are referred to as a urinary tract infection [...]

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2009.02304.x Byline: Jane L. Givens (*[dagger][double dagger]), Dan K. Kiely ([dagger]), Kristen Carey ([double dagger]), Susan L. Mitchell (*[dagger][double dagger]) Keywords: healthcare proxy; surrogate decision-making; advanced dementia Abstract: OBJECTIVES: To describe the medical decisions confronting healthcare proxies (HCPs) of nursing home (NH) residents with advanced dementia and to identify factors associated with greater decision-making satisfaction. DESIGN: Prospective cohort study. SETTING: Twenty-two Boston-area NHs. PARTICIPANTS: Three hundred twenty-three NH residents with advanced dementia and their HCPs. MEASUREMENTS: Decisions made by HCPs over 18 months were ascertained quarterly. After making a decision, HCPs completed the Decision Satisfaction Inventory (DSI) (range 0-100). Independent variables included HCP and resident sociodemographic characteristics, health status, and advance care planning. Multivariable linear regression identified factors associated with higher DSI scores (greater satisfaction). RESULTS: Of 323 HCPs, 123 (38.1%) recalled making at least one medical decision; 232 decisions were made, concerning feeding problems (27.2%), infections (20.7%), pain (12.9%), dyspnea (8.2%), behavior problems (6.9%), hospitalizations (3.9%), cancer (3.0%), and other complications (17.2%). Mean DSI score[+ or -]standard deviation was 78.4[+ or -]19.5, indicating high overall satisfaction. NH provider involvement in shared decision-making was the area of least satisfaction. In adjusted analysis, greater decision-making satisfaction was associated with the resident living on a special care dementia unit (P=.002), greater resident comfort (P=.004), and the HCP not being the resident's child (P=.02). CONCLUSION: HCPs of NH patients with advanced dementia can most commonly expect to encounter medical decisions relating to feeding problems, infections, and pain. Inadequate support from NH providers is the greatest source of HCP dissatisfaction with decision-making. Greater resident comfort and care in a special care dementia unit are potentially modifiable factors associated with greater decision-making satisfaction. Author Affiliation: (*)Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts ([dagger])Hebrew SeniorLife Institute for Aging Research, Boston, Massachusetts ([double dagger])Department of Medicine, Harvard Medical School, Boston, Massachusetts. Article note: Address correspondence to Jane L. Givens, MD, MSCE, Hebrew SeniorLife Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131. E-mail: JaneGivens@hrca.harvard.edu

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2009.02227.x Byline: Manisha Juthani-Mehta (*), Vincent Quagliarello (*), Eleanor Perrelli (*), Virginia Towle (*), Peter H. Van Ness (*), Mary Tinetti (*) Keywords: UTI; nursing home; long-term care; definition; infection control Abstract: OBJECTIVES: To identify clinical features associated with bacteriuria plus pyuria in noncatheterized nursing home residents with clinically suspected urinary tract infection (UTI). DESIGN: Prospective, observational cohort study from 2005 to 2007. SETTING: Five New Haven, Connecticut area nursing homes. PARTICIPANTS: Five hundred fifty-one nursing home residents each followed for 1 year for the development of clinically suspected UTI. MEASUREMENTS: The combined outcome of bacteriuria (>100,000 colony forming units from urine culture) plus pyuria (>10 white blood cells from urinalysis). RESULTS: After 178,914 person-days of follow-up, 228 participants had 399 episodes of clinically suspected UTI with a urinalysis and urine culture performed; 147 episodes (36.8%) had bacteriuria plus pyuria. The clinical features associated with bacteriuria plus pyuria were dysuria (relative risk (RR)=1.58, 95% confidence interval (CI)=1.10-2.03), change in character of urine (RR=1.42, 95% CI=1.07-1.79), and change in mental status (RR=1.38, 95% CI=1.03-1.74). CONCLUSION: Dysuria, change in character of urine, and change in mental status were significantly associated with the combined outcome of bacteriuria plus pyuria. Absence of these clinical features identified residents at low risk of having bacteriuria plus pyuria (25.5%), whereas presence of dysuria plus one or both of the other clinical features identified residents at high risk of having bacteriuria plus pyuria (63.2%). Diagnostic uncertainty still remains for the vast majority of residents who meet only one clinical feature. If validated in future cohorts, these clinical features with bacteriuria plus pyuria may serve as an evidence-based clinical definition of UTI to assist in management decisions. Author Affiliation: (*)From the Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut. Article note: Address correspondence to Manisha Juthani-Mehta, PO Box 208022, New Haven, CT 06520. E-mail: manisha.juthanimehta@yale.edu

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2008.01967.x Byline: Stephen R. Benoit (*), Wato Nsa ([dagger]), Chesley L. Richards (*), Dale W. Bratzler ([dagger]), Abigail M. Shefer ([double dagger]), Lynn M. Steele (*), John A. Jernigan (*) Keywords: nursing homes; antimicrobial use; infection Abstract: OBJECTIVES: To describe antimicrobial prescribing patterns in nursing homes. DESIGN: Retrospective, observational study. SETTING: Total of 73 nursing homes in four U.S. states; study period was from September 1, 2001, through February 28, 2002. PARTICIPANTS: Four thousand seven hundred eighty nursing home residents. MEASUREMENTS: Number and type of antimicrobials, indication for their use, and resident and facility factors associated with antimicrobial use in nursing homes. RESULTS: Of 4,780 residents, 2,017 (42%) received one or more antibiotic courses. Overall, residents received a mean of 4.8 courses/1,000 resident-days (mean facility range 0.4-23.5). In multivariable analysis, higher probability of nursing home discharge and of being categorized in the rehabilitation, extensive services, special care, or clinically complex Resource Utilization Groups were associated with higher rates of antimicrobial usage. Three drug classes accounted for nearly 60% of antimicrobial courses-fluoroquinolones (38%), first-generation cephalosporins (11%), and macrolides (10%). The most common conditions for which antimicrobials were prescribed were respiratory tract (33%) and urinary tract (32%) infections. CONCLUSION: Antibiotic use is variable in nursing homes. Targeting educational and other antimicrobial use interventions to the treatment of certain clinical diagnoses and conditions may be an appropriate strategy for optimizing antimicrobial use in this setting. Author Affiliation: (*)Division of Healthcare Quality Promotion ([double dagger])Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, Georgia ([dagger])Oklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma. Article note: Address correspondence to Stephen Benoit, MD, MPH, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-51, Atlanta, GA 30033. E-mail: SBenoit@cdc.gov

* Objective. - Nine outbreaks of group A streptococcal (GAS) infections in nursing homes were reported to the Centers for Disease Control (Atlanta, Ga) during the past two winters. We conducted an intensive epidemiologic and laboratory investigation of one of these outbreaks to determine clinical characteristics, risk factors for transmission and infection,and methods of control and prevention. Methods. - Cases were detected using cultures and serologic tests. Matched case-control and retrospective cohort studies were performed to determine risk factors for infection. Results. - Because December 13, 1989, and January 31, 1990, 16 (20%) of 80 residents, and three (7%) of 45 staff, were infected with GAS. Eleven of the residents had invasive disease and four died. Isolates were available from four persons; all were serotype M-1, T-1. There was strong spatial clustering of cases within the nursing home; having a roommate with prior infection was the most important risk factor. Residents with preexisting decubiti had a reduced risk of infection, perhaps because of stricter infection control practices in their care. No evidence was found for common-source transmission of infection. No further cases occurred after improvement of infection control practices and administration of prophylactic antimicrobials to all residents and staff. Conclusions. - Invasive GAS disease is increasing nationwide, and is a potentially serious problem in the growing and high-risk setting of nursing homes. These data suggest that, in this outbreak, a virulent GAS strain was introduced, with subsequent person-to-person transmission. Adherence to infection control practices can prevent or control GAS outbreaks. Prophylactic antimicrobials may be an effective adjunct to control severe or ongoing outbreaks. (Arch Intern Med. 1992; 152:1017-1022)

According to the Centers for Disease Control and Prevention (CDC), approximately 15% of nursing home residents have infections, including wound infections, respiratory infections, urinary tract infections, or pneumonia. Another sobering [...]

Functionally and medically defined subgroups of nursing home populations Introduction Describing the functional and health status characteristics of the U.S. nursing home population is difficult because of the extreme age [...]

Research findings, 'Three-year prevalence of healthcare-associated infections in Dutch nursing homes,' are discussed in a new report. According to a study from Nijmegen, Netherlands, 'From November 2007 for a period [...]

Respiratory Infections in Nursing Homes Abstract & Commentary Synopsis: Eight variables predicted mortality from lower respiratory tract infections in nursing home residents, and these variables can be used to make [...]

C. pneumoniae Causes Infectious Outbreaks in Nursing Homes Acute respiratory infections are a substantial source of morbidity and mortality in the elderly, yet little study has been done in the [...]

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2009.02277.x Byline: Lindsay E. Nicolle (*) Author Affiliation: (*)Departments of Internal Medicine and Medical Microbiology, University of Manitoba Health Sciences, Winnipeg, Manitoba, Canada Article note: Address correspondence to Lindsay E. Nicolle, Department of Internal Medicine and Department of Medical Microbiology, University of Manitoba Health Sciences Centre, Rm GG 443-820 Sherbrook Street, Winnipeg, MB, Canada R3A 1R9. E-mail: lnicolle@hsc.mb.ca

Nosocomial infections are the major source of morbidity and mortality in long-term care facilities. (1) Over the past two decades, the prevalence of infection in long-term care settings has been [...]

CHICAGO - Pneumonia may be a preventable disease for some nursing home residents. Nursing home acquired pneumonia is the most common infection of people who live in long-term care facilities. [...]

CHICAGO - Adherence to guidelines for treating community-acquired pneumonia in the late 1990s was associated with a higher death rate and more adverse effects when they were applied to elderly [...]