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.
Highlights
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
The study population consisted of residents of the Tayside region in Scotland aged 65 or over in 2005 who were admitted to Ninewells Hospital between 1st January and 31st December 2005, had at least one sample sent for culture, and were either; i) discharged with an ICD 10 code for lower respiratory tract infection (LRTI), skin and soft tissue infection (SSTI), or urinary tract infection (UTI), or ii) identified opportunistically during screening for related cohort studies
The most common sites of infection were the lower respiratory tract for patients admitted from their own home and the urinary tract for patients admitted from care homes (Table 1), but the overall distribution of sites of infection was similar for both groups of patients (χ2 = 6.00, df = 4, p = 0.199)
Summary
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. Multi-morbid and vulnerable, and likely to have indwelling devices. They are frequently admitted to hospitals, with a greater risk of colonisation with, and transmission of, resistant organisms from acute care facilities [1]. 50-75% residents in long-term care facilities are exposed to at least one course of antibiotics each year [6]
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