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Causes of infection in long-term care facilities: An overview

Michael J Richards, MD, FRACP
Rhonda L Stuart, MBBS, FRACP, PhD
Section Editor
Anthony Harris, MD, MPH
Deputy Editor
Elinor L Baron, MD, DTMH


Long-term care facilities (LTCFs) represent a diverse group of healthcare settings that serve individuals of all ages and provide variable degrees of care. LTCFs include nursing homes, skilled-nursing facilities providing postacute care, assisted living facilities, retirement homes, rehabilitation centers, long-term care hospitals, long-term psychiatric facilities, and institutions for individuals with intellectual disabilities. For many residents, these facilities are a home as well as a place of nursing, medical, and/or psychosocial care.

LTCFs provide a unique environment for transmission of infection between residents [1-4]. Types of infections and important pathogens in LTCFs will be reviewed here. Issues related to infection control in LTCFs are discussed separately. (See "Principles of infection control in long-term care facilities".)


Important types of infection in long-term care facilities (LTCFs) include respiratory tract infection, gastrointestinal infection, urinary tract infection, and skin and soft tissue infection [5]. Together, these infections represent 94 percent of infections seen in LTCFs [2,3,6,7].

Respiratory tract infection

Pneumonia — Mortality due to pneumonia is higher among residents of LTCFs than adults in the community. In addition, an episode of pneumonia in a LTCF resident is associated with increased mortality that persists for up to two years [8]. Predisposing factors include underlying obstructive pulmonary disease, left heart failure, and risk of aspiration [9,10]. Aspiration pneumonia is common in the presence of risk factors including stroke, neuromuscular disorders, or impaired consciousness.

Pneumonia in LTCFs may be caused by pathogens associated with community-acquired pneumonia or hospital-acquired pneumonia. The microbiology depends on whether residents have recently been in an acute care facility and their length of stay in the LTCF. Streptococcus pneumoniae is the most common pathogen [11,12]. Atypical pathogens such as Mycoplasma pneumoniae are less common in LTCFs than the general community.

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Literature review current through: Nov 2017. | This topic last updated: Sep 26, 2017.
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