PURPOSE: Although lower respiratory tract infections are a leading cause of death in frail elderly patients, few studies have compared treatments and outcomes. We assessed the effects of different antibiotic treatment strategies on survival of elderly nursing home residents with lower respiratory tract infections in the United States and the Netherlands, where treatment approaches are quite different. METHODS: We combined data from 2 prospective cohort studies of lower respiratory tract infections conducted in 36 nursing homes in the United States and 61 in the Netherlands. We included residents whose infections were treated with antibiotics: 806 in the United States and 415 in the Netherlands. Outcome measures were 1-month and 3-month mortality. We used logistic regression to adjust for differing illness severity. RESULTS: Dutch residents had higher mortality than US residents (28.1% vs 15.1% at 1 month, respectively; P <.001). After adjusting for illness severity with logistic regression, the differences between the Dutch and US populations were not significant (odds ratio 1.34; 95% confidence interval, 0.94-1.90). Predicted mortality was overestimated for more severely ill US residents at 1 month but not at 3 months. No antibiotic regimen was consistently associated with increased or decreased mortality. CONCLUSION: Despite differences in illness severity and treatment, adjusted mortality did not differ between the 2 countries. Although we cannot exclude a short-term survival benefit from more aggressive treatment in the United States, differences in baseline health appear prognostically more important than the type of antibiotic treatment.
PURPOSE: Although lower respiratory tract infections are a leading cause of death in frail elderly patients, few studies have compared treatments and outcomes. We assessed the effects of different antibiotic treatment strategies on survival of elderly nursing home residents with lower respiratory tract infections in the United States and the Netherlands, where treatment approaches are quite different. METHODS: We combined data from 2 prospective cohort studies of lower respiratory tract infections conducted in 36 nursing homes in the United States and 61 in the Netherlands. We included residents whose infections were treated with antibiotics: 806 in the United States and 415 in the Netherlands. Outcome measures were 1-month and 3-month mortality. We used logistic regression to adjust for differing illness severity. RESULTS: Dutch residents had higher mortality than US residents (28.1% vs 15.1% at 1 month, respectively; P <.001). After adjusting for illness severity with logistic regression, the differences between the Dutch and US populations were not significant (odds ratio 1.34; 95% confidence interval, 0.94-1.90). Predicted mortality was overestimated for more severely ill US residents at 1 month but not at 3 months. No antibiotic regimen was consistently associated with increased or decreased mortality. CONCLUSION: Despite differences in illness severity and treatment, adjusted mortality did not differ between the 2 countries. Although we cannot exclude a short-term survival benefit from more aggressive treatment in the United States, differences in baseline health appear prognostically more important than the type of antibiotic treatment.
Authors: M S Niederman; L A Mandell; A Anzueto; J B Bass; W A Broughton; G D Campbell; N Dean; T File; M J Fine; P A Gross; F Martinez; T J Marrie; J F Plouffe; J Ramirez; G A Sarosi; A Torres; R Wilson; V L Yu Journal: Am J Respir Crit Care Med Date: 2001-06 Impact factor: 21.405
Authors: Elisabeth Broex; Boudewijn Catry; Katrien Latour; Karl Mertens; Vanessa Vankerckhoven; Arno Muller; Rudi Stroobants; Peter Zarb; Herman Goossens; Béatrice Jans Journal: Drugs Aging Date: 2011-10-01 Impact factor: 3.923
Authors: Christine R Kovach; Brent R Logan; Michelle R Simpson; Sheila Reynolds Journal: Am J Alzheimers Dis Other Demen Date: 2010-03-17 Impact factor: 2.035
Authors: Christine R Kovach; Michelle R Simpson; Laura Joosse; Brent R Logan; Patricia E Noonan; Sheila A Reynolds; Diana Lynn Woods; Hershel Raff Journal: Res Gerontol Nurs Date: 2012-09-17 Impact factor: 1.571