Nursing home-associated bloodstream infection: A scoping review

Objective: To update a 2005 review of nursing home-associated bloodstream infection (NHABSI) regarding sources, organisms, antibiotic resistance, and outcome. Methods: A scoping review of studies of NHABSI identified by searching Google Scholar and Medline with OVID for the period January 1, 2004, to June 30, 2021, was conducted. Results: Overall, 6 studies of NHABSI were identified. Only 1 study was conducted with residents in North American facilities whereas in the 2005 review all studies were conducted in North America. Escherichia coli was the most common blood isolate, the urinary tract was the most common source of NHABSI; and the case-fatality rates ranged from 21% to 28%. These findings were comparable to those in the 2005 review. However, the proportion of NHABSI episodes due to antibiotic-resistant organisms increased substantially compared to the 2005 review. The most common antibiotic-resistant organisms were extended-spectrum β-lactamase-producing E. coli and Klebsiella spp. The 2 studies that evaluated the relationship between appropriate empiric antibiotic therapy and outcome came to different conclusions. Conclusions: The only major difference between the 2 reviews in the epidemiology of NHABSI was the marked increase in antibiotic resistance among blood isolates. Despite the increased antibiotic resistance, the case fatality rates in the current review were comparable to those reported in the 2005 review. However, the impact of appropriate empiric antibiotic therapy on outcome of NHABSI remains unclear.