Different impact of the appropriateness of empirical antibiotics for bacteremia among younger adults and the elderly in the ED.

Sept 2012

Lee CC, Chang CM, Hong MY, Hsu HC, Ko WC.

Source

Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan.

Abstract

OBJECTIVES:

 To investigate the clinical impact of age on bacteremia among adults visiting the emergency department (ED).

METHODS:

 Bacteremic adults visiting the ED from January 2008 to December 2008 were identified retrospectively. Demographic characteristics, severity, bacteremic pathogens with in vitro susceptibility, antimicrobial agents, and outcomes determined from chart records were analyzed as a case-control study.

RESULTS:

 Of 518 eligible bacteremic adults, 288 fifty six percent elderly patients greater then 65 years old were case patients and 230 younger patients, less then 65 years  were regarded as control patients. The 28-day mortality rate was higher in the case patients than that in the control patients (11.8% vs 6.1%, P = .02). The proportion of inappropriate empirical antibiotic therapy between the survivors and nonsurvivors was similar in control patients (69.4% vs 64.3%, P = .77); but for the case patients, the proportion of inappropriate empirical antibiotic therapy in the survivors was lower than that in the non-survivors (27.6% vs 44.1%, P = .04). Of note, inappropriate empirical antibiotic therapy was also one of independent risk factors of 28-day mortality by the multivariate analyses in the case patients (odds ratio [OR] 3.65; P = .049). Other independent predictors of 28-day mortality in case patients included a high Pittsburgh bacteremia score (≥4 points; OR 22.16; P < .001), bacteremia due to foci other than urinary tract infection (OR 9.07; P = .002), malignancy (OR 10.87; P < .001), coronary artery disease (OR 5.68; P = .01), and high serum creatinine (>1.5 mg/dL; OR 3.44; P = .04).

CONCLUSIONS:

For bacteremic adults, this study demonstrated the impact of inappropriate empirical antibiotic therapy on patients' outcome in the elderly was greater than that in the younger adults.

PubMed

Different patterns in use of antibiotics for lower urinary tract infection in institutionalized and home-dwelling elderly: a register-based study.

Aug 2012

Haasum Y, Fastbom J, Johnell K.

Source

Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Gävlegatan 16, 113 30, Stockholm, Sweden, Ylva.Haasum@ki.se.

Abstract

PURPOSE:

We compared the quality and pattern of use of antibiotics to treat urinary tract infection (UTI) between institutionalized and home-dwelling elderly.

METHODS:

We analyzed the quality of use of UTI antibiotics in Swedish people aged ≥65 years at 30 September 2008 (1,260,843 home-dwelling and 86,721 institutionalized elderly). Data regarding drug use, age and sex were retrieved from the Swedish Prescribed Drug Register and information about type of housing from the Social Services Register. In women, we assessed: (1) the proportion who use quinolones (should be as low as possible); (2) the proportion treated with the recommended drugs (pivmecillinam, nitrofurantoin, or trimethoprim) (proportions should be about 40 %, 40 % and 15-20 %, respectively); In men, we assessed: (1) the proportion who used quinolones or trimethoprim (should be as high as possible).

RESULTS:

The 1-day point prevalence for antibiotic use for UTI was 1.6 % among institutionalized and 0.9 % among home-dwelling elderly. Of these, about 15 % of institutionalized and 19 % of home-dwelling women used quinolones. The proportion of women treated with the recommended drugs pivmecillinam, nitrofurantoin or trimethoprim was 29 %, 27 % and 45 % in institutions and 40 %, 28 % and 34 % for home-dwellers. In men treated with antibiotics for UTI, quinolones or trimethoprim were used by about 76 % in institutions and 85 % in home-dwellers.

CONCLUSIONS:

Our results indicate that recommendations for UTI treatment with antibiotics are not adequately followed. The high use of trimethoprim amongst institutionalized women and the low use of quinolones or trimethoprim among institutionalized men need further investigation.

PubMed