Nosocomial Urinary‐Tract Infections in a Skilled Nursing Facility†

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Abstract
Fifty‐five documented infections reported from an admission unit of a large skilled nursing facility (SNF) during a five‐month period were analyzed. Of these, 45 (82 percent) were urinary‐tract infections (UTIs), chiefly asymptomatic bacteriuria. Sixty‐three percent of the UTIs were acquired in the SNF, and the remainder were acquired during the preceding stay in a general hospital. Statistically, Proteus species infections were more common among the SNF‐acquired UTIs, whereas Pseudomonas aeruginosa infections were the most common among the hospital‐acquired UTIs. The following recommendations are made: 1) for previously hospitalized elderly patients in whom urinary‐tract sepsis develops soon after admission to an SNF, treatment should start with an antibiotic active against Pseudomonas aeruginosa while the results of cultures are pending; 2) symptomatic lower urinary‐tract infections caused by SNF‐acquired Proteus species should be treated with nalidixic acid or trimethoprim**‐sulfamethoxazole; 3) the term “nosocomial infection” should be broadened to include infections acquired in long‐term care institutions; and 4) infection surveillance should be started in selected long‐term care institutions for the elderly as part of an expanded National Nosocomial Infections Survey.