Association between institutionalization and carriage of multiresistant bacteria in the elderly at the time of admission to a general hospital

The impact of institutionalization on the carriage of multiresistant bacter ia among the elderly was assessed prospectively by comparing the carriage r ate in institutionalized patients over 70 years of age to the carriage rate in patients over 70 living at home (58 patients / group). Nares, skin, and rectal swabs were obtained within 24 h of admission to the hospital. Among the 20 carriers identified, 75% came from institutions. Significantly, ins titutionalized patients were incontinent (P<0.001), less autonomous than th ose living at home (P<10(-6)), and had taken antibiotics recently (P<0.02). The primary characteristics associated with bacterial colonization were in stitutional living (P<0.02), having at least one underlying disease (P<0.00 1), dependence (Karnofsky index less than or equal to 50; P<0.02), recent t reatment with antibiotics (P<0.02), and the presence of skin lesions (P < 0 .02). Among the risk factors identified, institutionalization can be readil y determined upon admission; systematic communication of carrier status of transfer patients would improve overall patient care.