This study sought to reevaluate the epidemiology of bloodstream infection in nursing home residents. The records of 166 nursing home residents admitted to an urban, public, university-affiliated hospital with 169 episodes of bloodstream infection between January 1997 and April 2000 were retrospectively reviewed. The most common organisms isolated were Escherichia coli (27% of isolates), Staphylococcus aureus (18%; 29% were methicillin-resistant strains), and Proteus mirabilis (13%). There was minimal resistance to quinolones and third-generation cephalosporins among aerobic gram-negative bacilli. The most common sources were the urinary tract (51% of episodes) and the lungs (11%); a source was not identified in 22% of episodes. Hospital mortality was 18%. Independent predictors of hospital mortality were a pulmonary source of infection, systolic blood pressure <90 mm Hg, and leukocytosis >20,000 cells/mm3. Compared with other studies published in the past 2 decades, mortality was lower. The most common resistant organism was methicillin-resistant S. aureus.