RISK-FACTORS FOR COLONIZATION WITH YEAST SPECIES IN A VETERANS AFFAIRS LONG-TERM-CARE FACILITY

OBJECTIVES: To assess colonization and serious infection with yeasts a nd the risk factors that are associated with colonization by these org anisms. DESIGN: Monthly surveillance for colonization and infection ov er a period of 2 years. SETTING: A long-term-care facility (LTCF) atta ched to an acute-care Veterans Affairs Medical Center. PARTICIPANTS: T he 543 men and 10 women in the facility. MEASUREMENTS: Colonization an d serious infection rates with yeasts. Analysis of risk factors associ ated with yeast colonization of residents. RESULTS: Colonization rates were relatively stable during the 2-year period (53 +/- 1.8% patients colonized per month). Candida albicans was the most common colonizer, found in 35 +/- .9% of patients colonized per month. The pharynx was the most commonly colonized site, with 41 +/- 1.4% of patients per mon th with pharyngeal colonization. Eighty-four percent of patients remai ning in the facility for 3 or more months were colonized by yeast at s ome time during their stay. Presence of neurogenic bladder, leg amputa tion, or a low serum albumin were independently associated with yeast colonization; neither diabetes mellitus nor functional status was a ri sk factor for colonization by yeasts. Only four serious yeast infectio ns in four patients (esophagitis and three urinary tract infections) w ere found during the 2-year period; all infections occurred in patient s who were colonized by yeasts previously. CONCLUSION: In our LTCF, co lonization of patients by yeasts occurred commonly in those residents remaining in the facility for 3 or more months. However, serious yeast infections occurred infrequently. It is likely that colonization of r esidents of LTCFs by yeasts may only become clinically important when the patient is transferred to an acute-care hospital where additional risk factors may allow the development of serious yeast infection.