Is antibacterial treatment intensity lower in elderly patients? A retrospective cohort study in a German surgical intensive care unit
Abstract Background Demographic change concurrent with medical progress leads to an increasing number of elderly patients in intensive care units (ICUs). Antibacterial treatment is an important, often life-saving, aspect of intensive care but burdened by the associated antimicrobial resistance risk....
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-06-01
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| Series: | BMC Health Services Research |
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| Online Access: | http://link.springer.com/article/10.1186/s12913-019-4204-0 |
| _version_ | 1818020085179088896 |
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| author | Dominik Beier Christel Weiß Michael Hagmann Ümniye Balaban Manfred Thiel Verena Schneider-Lindner |
| author_facet | Dominik Beier Christel Weiß Michael Hagmann Ümniye Balaban Manfred Thiel Verena Schneider-Lindner |
| author_sort | Dominik Beier |
| collection | DOAJ |
| description | Abstract Background Demographic change concurrent with medical progress leads to an increasing number of elderly patients in intensive care units (ICUs). Antibacterial treatment is an important, often life-saving, aspect of intensive care but burdened by the associated antimicrobial resistance risk. Elderly patients are simultaneously at greater risk of infections and may be more restrictively treated because, generally, treatment intensity declines with age. We therefore described utilization of antibacterials in ICU patients older and younger than 80 years and examined differences in the intensity of antibacterial therapy between both groups. Methods We analysed 17,464 valid admissions from the electronic patient data management system of our surgical ICU from April 2006 – October 2013. Antibacterial treatment rates were defined as days of treatment (exposed patient days) relative to patient days of ICU stay and calculated for old and young patients. Rates were compared in zero-inflated Poisson regression models adjusted for patients’ sex, mean SAPS II- and TISS-scores, and calendar years yielding adjusted rate ratios (aRRs). Rate ratios exceeding 1 represent higher rates in old patients reflecting greater treatment intensity in old compared to younger patients. Results Observed antibacterial treatment rates were lower in patients 80 years and older compared to younger patients (30.97 and 39.73 exposed patient days per 100 patient days in the ICU, respectively). No difference in treatment intensity, however, was found from zero-inflated Poisson regression models permitting more adequate consideration of patient days with low treatment probability: for all antibacterials the adjusted rate ratio (aRR) was 1.02 (95%CI: 0.98–1.07). Treatment intensities were higher in elderly patients for penicillins (aRR 1.37 (95%CI: 1.26–1.48)), cephalosporins (aRR 1.20 (95%CI: 1.09–1.31)), carbapenems (aRR 1.35 (95%CI: 1.20–1.50)), fluoroquinolones (aRR 1.17 (95%CI: 1.05–1.30), and imidazoles (aRR 1.34 (95%CI: 1.23–1.46)). Conclusions Elderly patients were generally less likely to be treated with antibacterials. This observation, however, did not persist in patients with comparable treatment probability. In these, antibacterial treatment intensity did not differ between younger and older ICU patients, for some antibacterial classes treatment intensity was even higher in the latter. Patient-level covariates are instrumental for a nuanced evaluation of age-effects in antibacterial treatment in the ICU. |
| first_indexed | 2024-04-14T08:01:20Z |
| format | Article |
| id | doaj.art-572ae442213b43929b0fbba455884c9f |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-14T08:01:20Z |
| publishDate | 2019-06-01 |
| publisher | BMC |
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| series | BMC Health Services Research |
| spelling | doaj.art-572ae442213b43929b0fbba455884c9f2022-12-22T02:04:54ZengBMCBMC Health Services Research1472-69632019-06-011911910.1186/s12913-019-4204-0Is antibacterial treatment intensity lower in elderly patients? A retrospective cohort study in a German surgical intensive care unitDominik Beier0Christel Weiß1Michael Hagmann2Ümniye Balaban3Manfred Thiel4Verena Schneider-Lindner5Department of Anesthesiology and Surgical Intensive Care Medicine, Medical Faculty Mannheim, Heidelberg UniversityDepartment of Biometry and Statistics, Medical Faculty Mannheim, Heidelberg UniversityDepartment of Biometry and Statistics, Medical Faculty Mannheim, Heidelberg UniversityDepartment of Anesthesiology and Surgical Intensive Care Medicine, Medical Faculty Mannheim, Heidelberg UniversityDepartment of Anesthesiology and Surgical Intensive Care Medicine, Medical Faculty Mannheim, Heidelberg UniversityDepartment of Anesthesiology and Surgical Intensive Care Medicine, Medical Faculty Mannheim, Heidelberg UniversityAbstract Background Demographic change concurrent with medical progress leads to an increasing number of elderly patients in intensive care units (ICUs). Antibacterial treatment is an important, often life-saving, aspect of intensive care but burdened by the associated antimicrobial resistance risk. Elderly patients are simultaneously at greater risk of infections and may be more restrictively treated because, generally, treatment intensity declines with age. We therefore described utilization of antibacterials in ICU patients older and younger than 80 years and examined differences in the intensity of antibacterial therapy between both groups. Methods We analysed 17,464 valid admissions from the electronic patient data management system of our surgical ICU from April 2006 – October 2013. Antibacterial treatment rates were defined as days of treatment (exposed patient days) relative to patient days of ICU stay and calculated for old and young patients. Rates were compared in zero-inflated Poisson regression models adjusted for patients’ sex, mean SAPS II- and TISS-scores, and calendar years yielding adjusted rate ratios (aRRs). Rate ratios exceeding 1 represent higher rates in old patients reflecting greater treatment intensity in old compared to younger patients. Results Observed antibacterial treatment rates were lower in patients 80 years and older compared to younger patients (30.97 and 39.73 exposed patient days per 100 patient days in the ICU, respectively). No difference in treatment intensity, however, was found from zero-inflated Poisson regression models permitting more adequate consideration of patient days with low treatment probability: for all antibacterials the adjusted rate ratio (aRR) was 1.02 (95%CI: 0.98–1.07). Treatment intensities were higher in elderly patients for penicillins (aRR 1.37 (95%CI: 1.26–1.48)), cephalosporins (aRR 1.20 (95%CI: 1.09–1.31)), carbapenems (aRR 1.35 (95%CI: 1.20–1.50)), fluoroquinolones (aRR 1.17 (95%CI: 1.05–1.30), and imidazoles (aRR 1.34 (95%CI: 1.23–1.46)). Conclusions Elderly patients were generally less likely to be treated with antibacterials. This observation, however, did not persist in patients with comparable treatment probability. In these, antibacterial treatment intensity did not differ between younger and older ICU patients, for some antibacterial classes treatment intensity was even higher in the latter. Patient-level covariates are instrumental for a nuanced evaluation of age-effects in antibacterial treatment in the ICU.http://link.springer.com/article/10.1186/s12913-019-4204-0AntibacterialsICUOlder patientsElectronic patient recordZero-inflated Poisson regression |
| spellingShingle | Dominik Beier Christel Weiß Michael Hagmann Ümniye Balaban Manfred Thiel Verena Schneider-Lindner Is antibacterial treatment intensity lower in elderly patients? A retrospective cohort study in a German surgical intensive care unit BMC Health Services Research Antibacterials ICU Older patients Electronic patient record Zero-inflated Poisson regression |
| title | Is antibacterial treatment intensity lower in elderly patients? A retrospective cohort study in a German surgical intensive care unit |
| title_full | Is antibacterial treatment intensity lower in elderly patients? A retrospective cohort study in a German surgical intensive care unit |
| title_fullStr | Is antibacterial treatment intensity lower in elderly patients? A retrospective cohort study in a German surgical intensive care unit |
| title_full_unstemmed | Is antibacterial treatment intensity lower in elderly patients? A retrospective cohort study in a German surgical intensive care unit |
| title_short | Is antibacterial treatment intensity lower in elderly patients? A retrospective cohort study in a German surgical intensive care unit |
| title_sort | is antibacterial treatment intensity lower in elderly patients a retrospective cohort study in a german surgical intensive care unit |
| topic | Antibacterials ICU Older patients Electronic patient record Zero-inflated Poisson regression |
| url | http://link.springer.com/article/10.1186/s12913-019-4204-0 |
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