title: Community acquired infections in older patients admitted to hospital from care homes versus the community: cohort study of microbiology and outcomes.
abstract: BACKGROUND
  Residents of care homes are at risk of colonisation and infection with antibiotic resistant bacteria, but there is little evidence that antibiotic resistance among such patients is associated with worse outcomes than among older people living in their own homes. Our aim was to compare the prevalence of antibiotic resistant bacteria and clinical outcomes in older patients admitted to hospital with acute infections from care homes versus their own homes.
  
  
  METHODS
  We enrolled patients admitted to Ninewells Hospital in 2005 who were older than 64 years with onset of acute community acquired respiratory tract, urinary tract or skin and soft tissue infections, and with at least one sample sent for culture. The primary outcome was 30 day mortality, adjusted for age, sex, Charlson Index of co-morbidity, sepsis severity, presence of resistant isolates and resistance to initial therapy.
  
  
  RESULTS
  161 patients were identified, 60 from care homes and 101 from the community. Care home patients were older, had more co-morbidities, and higher rates of resistant bacteria, including MRSA and Gram negative organisms resistant to co-amoxiclav, cefuroxime and/or ciprofloxacin, overall (70% versus 36%, p = 0.026). 30 day mortality was high in both groups (30% in care home patients and 24% in comparators). In multivariate logistic regression we found that place of residence did not predict 30 day mortality (adjusted odds ratio (OR) for own home versus care home 1.01, 95% CI 0.40-2.52, p = 0.984). Only having severe sepsis predicted 30 day mortality (OR 10.09, 95% CI 3.37-30.19, p < 0.001), after adjustment for age, sex, co-morbidity, presence of resistant bacteria, resistance to initial therapy, and place of residence.
  
  
  CONCLUSIONS
  Older patients admitted with acute infection had high 30 day mortality. Patients from care homes were more likely to have resistant organisms but high levels of antimicrobial resistance were found in both groups. Thus, we recommend that antibiotic therapies active against resistant organisms, guided by local resistance patterns, should be considered for all older patients admitted with severe sepsis regardless of their place of residence.
authors: Division of Population Health Sciences, Medical Research Institute, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, Scotland, UK. c.z.marwick@dundee.ac.uk
authors: Charis
authors: C
authors: Marwick
authors: Virginia Hernandez
authors: VH
authors: Santiago
authors: Colin
authors: C
authors: McCowan
authors: Janice
authors: J
authors: Broomhall
authors: Peter
authors: P
authors: Davey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D004352:Drug Resistance, Microbial / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000639:trends*; D010343:Patient Admission / Q000639:trends*; D012111:Residence Characteristics; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
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