BACKGROUND: Multidrug-resistant (MDR) gram-negative bacteria are reported increasingly frequently among isolates recovered from elderly patients. The clinical epidemiology of bloodstream infection (BSI) due to MDR gram-negative bacteria among elderly patients is unknown. OBJECTIVE: To characterize the clinical epidemiology of BSI due to MDR gram-negative bacteria among elderly patients at hospital admission in an effort to provide a greater understanding of these serious infections and ultimately to improve patient outcomes. DESIGN: Case-control study. SETTING: Tertiary care hospital in Boston, Massachusetts. PATIENTS: Patients 65 years of age and older. METHODS: From 1999 to 2007, computerized medical records were reviewed for BSI due to MDR gram-negative bacteria within 48 hours of hospital admission. Risk factors for BSI due to these bacteria were identified. RESULTS: MDR gram-negative bacteria were recovered from 61 (8%) of 724 elderly patients with BSI caused by gram-negative bacteria. Over the 8 1/2-year study period, the percentage of MDR gram-negative bacteria among bloodstream isolates increased from 2 (1%) of 199 to 34 (16%) of 216. Empiric therapy was ineffective for 38 (63%) of 60 patients with BSI caused by MDR gram-negative bacteria. The variables independently associated with BSI due to these bacteria were as follows: residency in a long-term care facility (odds ratio [OR], 4.9 [95% confidence interval {CI} 1.6-14.9]; P= .006), presence of an invasive device (OR, 6.0 [95% CI, 1.5-23.5]; P= .01), severe sepsis (OR, 7.9 [95% CI, 1.7-37.1]; P= .009), and delayed initiation of effective therapy (OR, 12.8 [95% CI, 3.9-41.1]; P= .001). CONCLUSION: The 16-fold increase in BSI due to MDR gram-negative bacteria at hospital admission among elderly patients, especially among those who resided in long-term care facilities prior to admission, contributes further to the expanding body of evidence that these patients are the main reservoirs of MDR gram-negative bacteria. Given their contribution to the influx of antimicrobial-resistant bacteria in the hospital setting, infection control interventions that target this high-risk group need to be considered.
BACKGROUND: Multidrug-resistant (MDR) gram-negative bacteria are reported increasingly frequently among isolates recovered from elderly patients. The clinical epidemiology of bloodstream infection (BSI) due to MDR gram-negative bacteria among elderly patients is unknown. OBJECTIVE: To characterize the clinical epidemiology of BSI due to MDR gram-negative bacteria among elderly patients at hospital admission in an effort to provide a greater understanding of these serious infections and ultimately to improve patient outcomes. DESIGN: Case-control study. SETTING: Tertiary care hospital in Boston, Massachusetts. PATIENTS: Patients 65 years of age and older. METHODS: From 1999 to 2007, computerized medical records were reviewed for BSI due to MDR gram-negative bacteria within 48 hours of hospital admission. Risk factors for BSI due to these bacteria were identified. RESULTS: MDR gram-negative bacteria were recovered from 61 (8%) of 724 elderly patients with BSI caused by gram-negative bacteria. Over the 8 1/2-year study period, the percentage of MDR gram-negative bacteria among bloodstream isolates increased from 2 (1%) of 199 to 34 (16%) of 216. Empiric therapy was ineffective for 38 (63%) of 60 patients with BSI caused by MDR gram-negative bacteria. The variables independently associated with BSI due to these bacteria were as follows: residency in a long-term care facility (odds ratio [OR], 4.9 [95% confidence interval {CI} 1.6-14.9]; P= .006), presence of an invasive device (OR, 6.0 [95% CI, 1.5-23.5]; P= .01), severe sepsis (OR, 7.9 [95% CI, 1.7-37.1]; P= .009), and delayed initiation of effective therapy (OR, 12.8 [95% CI, 3.9-41.1]; P= .001). CONCLUSION: The 16-fold increase in BSI due to MDR gram-negative bacteria at hospital admission among elderly patients, especially among those who resided in long-term care facilities prior to admission, contributes further to the expanding body of evidence that these patients are the main reservoirs of MDR gram-negative bacteria. Given their contribution to the influx of antimicrobial-resistant bacteria in the hospital setting, infection control interventions that target this high-risk group need to be considered.
Authors: Victor L Yu; Christine C C Chiou; Charles Feldman; Ake Ortqvist; Jordi Rello; Arthur J Morris; Larry M Baddour; Carlos M Luna; David R Snydman; Margaret Ip; Wen Chien Ko; M Bernadete F Chedid; Antoine Andremont; Keith P Klugman Journal: Clin Infect Dis Date: 2003-07-07 Impact factor: 9.079
Authors: Galo Peralta; M Blanca Sánchez; J Carlos Garrido; Inés De Benito; M Eliecer Cano; Luis Martínez-Martínez; M Pía Roiz Journal: J Antimicrob Chemother Date: 2007-07-20 Impact factor: 5.790
Authors: Rituparna Das; Virginia Towle; Peter H Van Ness; Manisha Juthani-Mehta Journal: Infect Control Hosp Epidemiol Date: 2010-11-22 Impact factor: 3.254
Authors: Jeffrey M Caterino; Robert Leininger; David M Kline; Lauren T Southerland; Salman Khaliqdina; Christopher W Baugh; Daniel J Pallin; Kurt B Stevenson Journal: J Am Geriatr Soc Date: 2017-04-25 Impact factor: 5.562
Authors: Lindsey P Koliscak; James W Johnson; James R Beardsley; David P Miller; John C Williamson; Vera P Luther; Christopher A Ohl Journal: Antimicrob Agents Chemother Date: 2013-09-16 Impact factor: 5.191