INFECTIONS IN LONG TERM CARE FACILITIES (LTCF) FOR THE ELDERLY
[Date of last update: Agosto 2021]
The LTCFs guarantee assistance of diversified intensity to guests who frequently suffer from complex pathologies and, in some cases, need support for vital functions (respirator, artificial nutrition, etc.). In Italy, approximately 21 elderly people per 1,000 are guests of LTCF, and approximately 210,000 are in condition of not self-sufficiency (16 for every 1,000 elderly residents) [1].
Older people, due to underlying chronic disease, functional impairment, malnutrition, and polytherapy, have a greater risk of contracting an infection and having a more severe disease course than other age groups. [3] In LTCFs the main HAIs are urinary, respiratory, skin or tissue and gastrointestinal tract infections. In the various European countries, cases of HAIs are reported between 2.7 and 11.8 per 1000 resident days with a prevalence between 2.2% and 4.4% [4].
LTCFs are an important reservoir of multidrug-resistant organisms (MDROs), and the MDROs colonization in residents is higher in Italy than in other European countries.
Patients in LTCFs have a high rate of positivity for carbapenem-resistant enterobacteriaceae (CRE) and mortality in infected patients is up to 75%. [5]
Bibliographic references of the text
[1] Gruppo di lavoro ISS Bioetica– COVID-19. Assistenza sociosanitaria residenziale agli anziani non autosufficienti: profili bioetici e biogiuridici. Rapporto ISS COVID-19 n. 6/2021, versione del 10 marzo 2021.
[2 ] Nguyen LKN, Megiddo I, Howick S. Challenges of infection prevention and control in Scottish long-term care facilities. Infect Control Hosp Epidemiol. 2020 Aug;41(8):943-945. doi: 10.1017/ice.2020.113. Epub 2020 Apr 22. PMID: 32317037
[3] Haenen APJ, Verhoef LP, Beckers A, Gijsbers EF, Alblas J, Huis A, Hulscher M, de Greeff SC, on behalf of the SNIV study group (2019). Surveillance of infections in long-term care facilities (LTCFs): The impact of participation during multiple years on health care-associated infection incidence. Epidemiology and Infection 147, e266, 1–8. https://doi.org/10.1017/S0950268819001328
[4] Aschbacher R, Pagani L, Migliavacca R, Pagani L; GLISTer (Gruppo di Lavoro per lo Studio delle Infezioni nelle Residenze Sanitarie Assistite e Strutture Assimilabili) working group. Recommendations for the surveillance of multidrug-resistant bacteria in Italian long-term care facilities by the GLISTer working group of the Italian Association of Clinical Microbiologists (AMCLI). Antimicrob Resist Infect Control. 2020 Jul 13;9(1):106. doi: 10.1186/s13756-020-00771-0. PMID: 32660605
[5] Chen HY, Jean SS, Lee YL, Lu MC, Ko WC, Liu PY, Hsueh PR. Carbapenem-Resistant Enterobacterales in Long-Term Care Facilities: A Global and Narrative Review. Front Cell Infect Microbiol. 2021 Apr 23;11:601968. doi: 10.3389/fcimb.2021.601968. eCollection 2021. PMID: 33968793
