Community acquired infections in older patients admitted to hospital from care homes versus the community

cohort study of microbiology and outcomes

Charis Marwick, Virginia Hernandez Santiago, Colin McCowan, Janice Broomhall, Peter Davey

    Research output: Contribution to journalArticle

    17 Citations (Scopus)

    Abstract

    Background
    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 versus their own homes.

    Methods
    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.

    Results
    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% versus 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 versus 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.

    Conclusions
    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.
    Original languageEnglish
    Article number12
    JournalBMC Geriatrics
    Volume13
    DOIs
    Publication statusPublished - 2013

    Fingerprint

    Community-Acquired Infections
    Home Care Services
    Microbiology
    Cohort Studies
    Mortality
    Bacteria
    Sepsis
    Patient Care
    Anti-Bacterial Agents
    Morbidity
    Infection
    Odds Ratio
    Amoxicillin-Potassium Clavulanate Combination
    Cefuroxime
    Soft Tissue Infections
    Methicillin-Resistant Staphylococcus aureus
    Ciprofloxacin
    Microbial Drug Resistance
    Urinary Tract
    Respiratory System

    Cite this

    @article{0d5b494da57f4ae89c9647aba94d3d43,
    title = "Community acquired infections in older patients admitted to hospital from care homes versus the community: cohort study of microbiology and outcomes",
    abstract = "BackgroundResidents 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 versus their own homes.MethodsWe 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.Results161 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{\%} versus 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 versus 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.ConclusionsOlder 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.",
    author = "Charis Marwick and {Hernandez Santiago}, Virginia and Colin McCowan and Janice Broomhall and Peter Davey",
    year = "2013",
    doi = "10.1186/1471-2318-13-12",
    language = "English",
    volume = "13",
    journal = "BMC Geriatrics",
    issn = "1471-2318",
    publisher = "BioMed Central",

    }

    Community acquired infections in older patients admitted to hospital from care homes versus the community : cohort study of microbiology and outcomes. / Marwick, Charis; Hernandez Santiago, Virginia; McCowan, Colin; Broomhall, Janice; Davey, Peter.

    In: BMC Geriatrics, Vol. 13, 12, 2013.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Community acquired infections in older patients admitted to hospital from care homes versus the community

    T2 - cohort study of microbiology and outcomes

    AU - Marwick, Charis

    AU - Hernandez Santiago, Virginia

    AU - McCowan, Colin

    AU - Broomhall, Janice

    AU - Davey, Peter

    PY - 2013

    Y1 - 2013

    N2 - BackgroundResidents 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 versus their own homes.MethodsWe 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.Results161 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% versus 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 versus 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.ConclusionsOlder 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.

    AB - BackgroundResidents 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 versus their own homes.MethodsWe 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.Results161 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% versus 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 versus 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.ConclusionsOlder 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.

    U2 - 10.1186/1471-2318-13-12

    DO - 10.1186/1471-2318-13-12

    M3 - Article

    VL - 13

    JO - BMC Geriatrics

    JF - BMC Geriatrics

    SN - 1471-2318

    M1 - 12

    ER -