title: Invasive pneumococcal disease in older adults residing in long-term care facilities and in the community.
abstract: OBJECTIVE
  To examine the epidemiology of invasive pneumococcal disease in older adults hospitalized for invasive pneumococcal disease who are living in the community and in long-term care facilities (LTCFs) in the United States.
  
  
  METHODS
  Analysis of 2402 cases of invasive pneumococcal disease requiring hospitalization in 2000 and 2001 that the Centers for Disease Control and Prevention's Active Bacterial Core Surveillance collected in nine states.
  
  
  METHODS
  Hospital.
  
  
  METHODS
  Hospitalized LTCF residents and community-living older adults in the United States.
  
  
  METHODS
  Age- and residence-specific pneumococcal disease incidence rates per 100000 persons, case-fatality rates, and trends in antimicrobial resistance.
  
  
  RESULTS
  Nationally, the rate of invasive pneumococcal disease in LTCF residents was 194.2 cases per 100000 persons aged 65 and older and 44.6 for community-living older adults (relative risk=4.4, 95% confidence interval (CI)=4.2-4.5). Compared with community-living older adults, case-fatality rates were 1.9 times higher (30.8% vs 16.0%, 95% CI=1.5-2.5). Pneumococcal strains from LTCF residents were significantly more likely to be nonsusceptible to levofloxacin than strains from community- living older adults (5.7% vs 0.4%, P<.001).
  
  
  CONCLUSIONS
  Older adults living in LTCFs are at a higher risk for invasive pneumococcal disease and death than are community-living older adults. Additionally, fluoroquinolone resistance is significantly higher in older adults living in LTCFs and may provide clues to emerging antimicrobial resistance in the general population.
authors.affiliation: Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. bbk3@cdc.org
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Kupronis
authors.forename: Chesley L
authors.initials: CL
authors.lastname: Richards
authors.forename: Cynthia G
authors.initials: CG
authors.lastname: Whitney
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality*; D012112:Residential Facilities; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D015996:Survival Rate; D014481:United States / Q000453:epidemiology