Incidence of antibiotic-resistant infection in long-term residents of skilled nursing facilities

Background: Information regarding the incidence of antibiotic-resistant infection in residents of skilled nursing facilities is lacking. Methods: The incidence and predictors of antibiotic-resistant infection were investigated in 56,182 long-term residents of 3314 skilled nursing facilities in California, Florida, Michigan, New York, and Texas. Results: The annual incidence was 12.7 cases per 1000 long-term residents overall, which varied by state (highest incidence, New York) and type of admitting facility (highest incidence, rehabilitation hospital). The incidence was greater in younger residents, males, and residents with paraplegia, quadriplegia, peripheral vascular disease, or diabetes mellitus. Dialysis, urinary catheterization, feeding tubes, tracheostomy, and use of intravenous medications were associated with elevated risk. Adjusted odds ratios (ORs) were greatest in residents with paraplegia (OR = 2.86; 95% confidence interval [CI] = 1.67 to 4.89) and those receiving dialysis (OR = 2.84; 95% CI = 1.84 to 4.37). Conclusion: There is significant variation in the risk of antibiotic-resistant infection by admitting diagnosis, device use, and facility characteristics.