Community acquired infections in older patients admitted to hospital from care homes versusthe 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.

Sepsis and Other Infectious Disease Emergencies in the Elderly

“…104 Significant resistance to fluoroquinolones and other antimicrobials have been documented in elderly community-dwelling and long-term care facility populations alike, due in part to widespread and sometimes lax use of antimicrobials. 87,91,98,99,106,107 Antibiograms detailing local antimicrobial resistance patterns for common urinary pathogens can help inform appropriate empiric therapy in the ED. Likewise, close outpatient follow-up to assess for clinical improvement and review of the appropriateness of empiric antimicrobial therapy based on urine culture results can help tailor further management.…”

Colonization with Multidrug-Resistant Organisms in Nursing Homes: Scope, Importance, and Management

“…Lee et al used a mathematical model to predict that use of contact precautions for all MRSA carriers would reduce prevalence of MRSA, but they did not anticipate changes in clinical outcome [64]. In a recent study, mortality in a cohort of older adults hospitalized because of infection acquired in NHs versus in their home was similar, despite a significantly higher percentage of resistance among strains responsible for NH-acquired infections [65]. In the case of VRE however, once systemic infection is established, a clear jump in mortality occurs compared to susceptible enterococci [33].…”

Prevenção e controle das infecções no domicílio: desafios e implicações para enfermagem

“…(12,13) Strategies of infection prevention and control should be expanded to include all health care scenarios. (6,7) Household environments have their own specificity in relation to hospitals, thus requiring specific actions of infection prevention and control. (4) Nonetheless, occupational risks in home care represent an area with insufficient investments especially in cross-infection and accident prevention.…”

“…In addition, professionals working in communities find limitations to prevent and control infection in households, especially due to social, cultural and environmental conditions varying from one home to another. (4)(5)(6) Besides these challenges, studies should be conducted to improve the understanding of the problem, find answers and help professionals make decisions towards better practices for biologically safe household environments.…”