Community acquired infections in older patients admitted to hospital from care homes <it>versus</it> the community: cohort study of microbiology and outcomes
<p>Abstract</p> <p>Background</p> <p>Residents of care homes are at risk of colonisation and infection with antibiotic resistant bacteria, but there is little evidence that antibiotic resistance among such patients is associated with worse outcomes than among older peop...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2013-02-01
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| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | http://www.biomedcentral.com/1471-2318/13/12 |
| _version_ | 1828833023808765952 |
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| author | Marwick Charis Santiago Virginia Hernandez McCowan Colin Broomhall Janice Davey Peter |
| author_facet | Marwick Charis Santiago Virginia Hernandez McCowan Colin Broomhall Janice Davey Peter |
| author_sort | Marwick Charis |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Residents of care homes are at risk of colonisation and infection with antibiotic resistant bacteria, but there is little evidence that antibiotic resistance among such patients is associated with worse outcomes than among older people living in their own homes. Our aim was to compare the prevalence of antibiotic resistant bacteria and clinical outcomes in older patients admitted to hospital with acute infections from care homes <it>versus</it> their own homes.</p> <p>Methods</p> <p>We enrolled patients admitted to Ninewells Hospital in 2005 who were older than 64 years with onset of acute community acquired respiratory tract, urinary tract or skin and soft tissue infections, and with at least one sample sent for culture. The primary outcome was 30 day mortality, adjusted for age, sex, Charlson Index of co-morbidity, sepsis severity, presence of resistant isolates and resistance to initial therapy.</p> <p>Results</p> <p>161 patients were identified, 60 from care homes and 101 from the community. Care home patients were older, had more co-morbidities, and higher rates of resistant bacteria, including MRSA and Gram negative organisms resistant to co-amoxiclav, cefuroxime and/or ciprofloxacin, overall (70% <it>versus</it> 36%, p = 0.026). 30 day mortality was high in both groups (30% in care home patients and 24% in comparators). In multivariate logistic regression we found that place of residence did not predict 30 day mortality (adjusted odds ratio (OR) for own home <it>versus</it> care home 1.01, 95% CI 0.40-2.52, p = 0.984). Only having severe sepsis predicted 30 day mortality (OR 10.09, 95% CI 3.37-30.19, p < 0.001), after adjustment for age, sex, co-morbidity, presence of resistant bacteria, resistance to initial therapy, and place of residence.</p> <p>Conclusions</p> <p>Older patients admitted with acute infection had high 30 day mortality. Patients from care homes were more likely to have resistant organisms but high levels of antimicrobial resistance were found in both groups. Thus, we recommend that antibiotic therapies active against resistant organisms, guided by local resistance patterns, should be considered for all older patients admitted with severe sepsis regardless of their place of residence.</p> |
| first_indexed | 2024-12-12T17:08:06Z |
| format | Article |
| id | doaj.art-ada0bb15271f42d19a5a1081cea3ec96 |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-12-12T17:08:06Z |
| publishDate | 2013-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-ada0bb15271f42d19a5a1081cea3ec962022-12-22T00:17:56ZengBMCBMC Geriatrics1471-23182013-02-011311210.1186/1471-2318-13-12Community acquired infections in older patients admitted to hospital from care homes <it>versus</it> the community: cohort study of microbiology and outcomesMarwick CharisSantiago Virginia HernandezMcCowan ColinBroomhall JaniceDavey Peter<p>Abstract</p> <p>Background</p> <p>Residents of care homes are at risk of colonisation and infection with antibiotic resistant bacteria, but there is little evidence that antibiotic resistance among such patients is associated with worse outcomes than among older people living in their own homes. Our aim was to compare the prevalence of antibiotic resistant bacteria and clinical outcomes in older patients admitted to hospital with acute infections from care homes <it>versus</it> their own homes.</p> <p>Methods</p> <p>We enrolled patients admitted to Ninewells Hospital in 2005 who were older than 64 years with onset of acute community acquired respiratory tract, urinary tract or skin and soft tissue infections, and with at least one sample sent for culture. The primary outcome was 30 day mortality, adjusted for age, sex, Charlson Index of co-morbidity, sepsis severity, presence of resistant isolates and resistance to initial therapy.</p> <p>Results</p> <p>161 patients were identified, 60 from care homes and 101 from the community. Care home patients were older, had more co-morbidities, and higher rates of resistant bacteria, including MRSA and Gram negative organisms resistant to co-amoxiclav, cefuroxime and/or ciprofloxacin, overall (70% <it>versus</it> 36%, p = 0.026). 30 day mortality was high in both groups (30% in care home patients and 24% in comparators). In multivariate logistic regression we found that place of residence did not predict 30 day mortality (adjusted odds ratio (OR) for own home <it>versus</it> care home 1.01, 95% CI 0.40-2.52, p = 0.984). Only having severe sepsis predicted 30 day mortality (OR 10.09, 95% CI 3.37-30.19, p < 0.001), after adjustment for age, sex, co-morbidity, presence of resistant bacteria, resistance to initial therapy, and place of residence.</p> <p>Conclusions</p> <p>Older patients admitted with acute infection had high 30 day mortality. Patients from care homes were more likely to have resistant organisms but high levels of antimicrobial resistance were found in both groups. Thus, we recommend that antibiotic therapies active against resistant organisms, guided by local resistance patterns, should be considered for all older patients admitted with severe sepsis regardless of their place of residence.</p>http://www.biomedcentral.com/1471-2318/13/12Long-term care facilitiesNursing homeCare homeSepsisSeverity of infectionAntibiotic policy |
| spellingShingle | Marwick Charis Santiago Virginia Hernandez McCowan Colin Broomhall Janice Davey Peter Community acquired infections in older patients admitted to hospital from care homes <it>versus</it> the community: cohort study of microbiology and outcomes BMC Geriatrics Long-term care facilities Nursing home Care home Sepsis Severity of infection Antibiotic policy |
| title | Community acquired infections in older patients admitted to hospital from care homes <it>versus</it> the community: cohort study of microbiology and outcomes |
| title_full | Community acquired infections in older patients admitted to hospital from care homes <it>versus</it> the community: cohort study of microbiology and outcomes |
| title_fullStr | Community acquired infections in older patients admitted to hospital from care homes <it>versus</it> the community: cohort study of microbiology and outcomes |
| title_full_unstemmed | Community acquired infections in older patients admitted to hospital from care homes <it>versus</it> the community: cohort study of microbiology and outcomes |
| title_short | Community acquired infections in older patients admitted to hospital from care homes <it>versus</it> the community: cohort study of microbiology and outcomes |
| title_sort | community acquired infections in older patients admitted to hospital from care homes it versus it the community cohort study of microbiology and outcomes |
| topic | Long-term care facilities Nursing home Care home Sepsis Severity of infection Antibiotic policy |
| url | http://www.biomedcentral.com/1471-2318/13/12 |
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