Sixteen-Fold Increase In Drug-Resitant Bacteria in Elderly Hospital Patients
According to a recent study, multidrug-resistant
(MDR) gram-negative bacteria are reported increasingly frequently among
samples recovered from elderly patients. The clinical epidemiology of
bloodstream infection (BSI) due to MDR gram-negative bacteria among
elderly patients is unknown.
From
1999 to 2007, computerized medical records were reviewed for BSI due to
MDR gram-negative bacteria within 48 hours of hospital admission in patients 65 years or older in a Boston, Massachusetts hospital.
MDR
gram-negative bacteria were recovered from 61 (8%) of 724 elderly
patients with BSI caused by gram-negative bacteria. Over the
-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];
), presence of an invasive device (OR, 6.0 [95% CI, 1.5–23.5];
), severe sepsis (OR, 7.9 [95% CI, 1.7–37.1];
), and delayed initiation of effective therapy (OR, 12.8 [95% CI, 3.9–41.1];
).
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. For more, see the study.
________________________________________________________________
Robert W. Carter, Jr. is a Virginia attorney whose law practice is
dedicated to protecting the rights of the victims of nursing
home and assisted living neglect and abuse in Richmond, Roanoke,
Norfolk, Lynchburg, Danville, Charlottesville, and across Virginia.
Posted on Fri, May 29, 2009
by Robert Carter