Antibiotic treatment and survival of nursing home patients with lower respiratory tract infection: a cross-national analysis.
OBJECTIVE
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.


CONCLUSIONS
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.
Kruse
Robin L
RL
Department of Family and Community Medicine, University of Missouri-Columbia, MO 65212, USA. kruser@health.missouri.edu
Mehr
David R
DR
van der Steen
Jenny T
JT
Ooms
Marcel E
ME
Madsen
Richard W
RW
Sherman
Ashley K
AK
D'Agostino
Ralph B
RB
van der Wal
Gerrit
G
Ribbe
Miel W
MW
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004363:Drug Utilization; D006801:Humans; D009426:Netherlands; D009735:Nursing Homes; D011014:Pneumonia / Q000188:drug therapy; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000401:mortality*; D012307:Risk Factors; D014481:United States
D000900:Anti-Bacterial Agents