ACUTE GASTROENTERITIS IN 3 COMMUNITY-BASED NURSING-HOMES

Background. Acute gastroenteritis is a cause of considerable morbidity and mortality in the elderly population. A prospective assessment of acute diarrhea in three community-based long-stay homes is described. Methods. A cohort study of acute gastroenteritis was performed in thre e community-based nursing homes, involving 572 residents over an 8-mon th period. Diarrhea cases were enrolled on the basis of the acute onse t of loose stools of greater than or equal to 24 hours, as well as one of the following: a rectal temperature of greater than or equal to 10 0 degrees F, dehydration, positive occult blood, greater than or equal to 48 hours duration, or as a part of any outbreak. Stool cultures fo r Clostridium difficile were performed on all NH 1 patients. Results. Fifty-three gastroenteritis cases were ascertained, consistent with in cidence rates of 14.6, 36.4, and 6.7 cases/100 patient years in NH 1, NK 2, and NH 3, respectively. Requiring a Foley catheter(OR = 2.57; 95 % CI, 0.93, 7.09) increased diarrhea risk. Six Clostridium difficile e nteritis cases and an episode attributable to Aeromonas/Pleisomonas sp ecies were diagnosed. One C. difficile diarrhea case was imported from hospital to NH 1. Ten of 12 fecal excretors resided in close geograph ic clusters in NH 1, where a majority of the latter were mobile and in continent of stool. Conclusions, Acute gastroenteritis was a common di sease in the study nursing homes, for which specific risk factors were identified. A predominant role for Clostridium difficile in the taxon omy of nursing home diarrheas was suggested.