1-102 Bloodstream Infection in Long-term Care Residents: An Integrative Review of the Literature

BACKGROUND: Residence in long-term care (LTC) facilities is a significant risk factor for harboring and transmittingmulti-drug resistant gram-negative (MDR-GN) organisms. This review examined the literature regarding MDR-GN bloodstream (BSI) infection in LTC residents. METHODS: We performed a review of studies focusing on MDRGN bloodstream infections in LTC residents. Guided byWhittemore and Knafl’s five stages of review, we identified articles published in English between January 1, 2005 and October 31, 2015. We conducted key word searches in the following electronic, scientific literature databases: Ovid Medline, EBSCO Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science, and Cochrane Central Register of Clinical Trials. In addition to the primary search, Google scholar and the reference lists of reviewed articles were examined for relevant citations. RESULTS: In total, 1, 022 studies were screened, and 345 abstracts reviewed. The full texts of 13 articles were examined as meeting selection criteria. The prevalence of MDR-GN BSI is rising among LTC residents. Two studies reported increases from 7% to 13% and from 1% to 16%. MDR-GN BSIs were higher among patients from LTC facilities compared to other hospital patients (14.5% vs. 2.5%). Mortality rates ranged from 10.4% to 46.8% and were higher in patients with MDR-GN BSI than without (37.5% vs. 3.6%). Direct admission from LTC was significantly associated with increased hospitalization (P u003c .001). Resistance to multiple antimicrobials for MDR-GN organisms raises concerns about therapeutic options; one study reported the initial inappropriate antibiotic prescription rate to be 59%. Six themes emerged from this integrative review (see Fig 1). CONCLUSIONS: There is an urgent need for additional research on the epidemiology of MDR-GN BSI in LTC, including colonization and transmission patterns, associated morbidity and mortality, and antibiotic stewardship programs targeting this unique population.