title: Antibiotics and mortality in patients with lower respiratory infection and advanced dementia.
abstract: OBJECTIVE
  To describe long-term mortality rate and to assess associations between mortality rate and antibiotic treatment of lower respiratory infection in patients with advanced dementia; antibiotic treatment allocation was independent of mortality risk-leaving less room for biased associations than in previous multicenter observational studies.
  
  
  METHODS
  Prospective study (2004-2009). Multilevel Cox proportional hazard analyses with adjustment for mortality risk were used to assess associations between antibiotics and mortality using time-dependent covariates.
  
  
  METHODS
  A US Department of Veterans Affairs nursing home.
  
  
  METHODS
  Ninety-four residents with advanced dementia who developed 109 episodes.
  
  
  METHODS
  Survival, treatment, mortality risk, illness severity, fluid intake, and several other patient characteristics.
  
  
  RESULTS
  Ten-day mortality was 48%, and 6-month mortality was 74%. Antibiotics were used in 77% of episodes. Overall, antibiotics were not associated with mortality rate (Hazard Ratio [HR] 0.70, Confidence Interval [CI] 0.38-1.30); however, antibiotics were associated with reduced 10-day mortality rate (HR 0.51, CI, 0.30-0.87; rate after 10 days: 1.5, CI 0.42-5.2). Benefit from antibiotics was less likely with inadequate fluid intake, and when experiencing the first episode.
  
  
  CONCLUSIONS
  In our sample of male nursing home residents with advanced dementia and lower respiratory infection, mortality was substantial despite antibiotic treatment. Antibiotics prolonged life but in many cases only for several days. Treatment decisions should take into account that antibiotics may delay death but may also prolong the dying process, indicating a need for accurate prediction of mortality and study of characteristics that may alter effectiveness of antibiotics.
authors: EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors: Jenny T
authors: JT
authors: van der Steen
authors: Patricia
authors: P
authors: Lane
authors: Neil W
authors: NW
authors: Kowall
authors: Dirk L
authors: DL
authors: Knol
authors: Ladislav
authors: L
authors: Volicer
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002423:Cause of Death; D015331:Cohort Studies; D003704:Dementia / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009735:Nursing Homes; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents