title: Carbapenem resistance and mortality in institutionalized elderly with urinary infection.
abstract: OBJECTIVE
  The emergence of antibiotic-resistant urinary pathogens represents a public health care concern. We aimed to detect antibiotic-resistance in elderly nursing home residents with urinary tract infection (UTI) and to assess the impact of carbapenem resistance on mortality.
  
  
  METHODS
  This cohort study of 196 patients with UTI confirmed by a positive urine culture was conducted in a nursing home in Italy. Data on 6-month mortality was obtained by nursing home records and confirmed by death certificates. Diagnosis of UTI was ascertained by urine culture. Antibiotic resistance was defined according to antibiograms performed by the same laboratory. Cox regression analysis was used to assess the adjusted association between carbapenem resistance and 6-month mortality.
  
  
  RESULTS
  Carbapenem resistance was found in 39/196 (20%) patients. After adjusting for potential confounders, carbapenem resistance was associated in Cox regression modeling with 6-month mortality (relative risk = 2.79; 95% confidence interval = 1.17-6.70; P = .021).
  
  
  CONCLUSIONS
  In elderly in-patients, UTI from carbapenem-resistant germs is an independent risk factor for 6-month mortality, irrespective of the etiologic agent. Further studies are needed to clarify the mechanisms underlying this association.
authors.affiliation: Fondazione San Raffaele-Cittadella della Carità, Taranto, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Marinosci
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zizzo
authors.forename: Anna
authors.initials: A
authors.lastname: Coppola
authors.forename: Leonardo
authors.initials: L
authors.lastname: Rodano
authors.forename: Alice
authors.initials: A
authors.lastname: Laudisio
authors.forename: Raffaele
authors.initials: R
authors.lastname: Antonelli Incalzi
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use*; D015331:Cohort Studies; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010360:Patient Transfer; D012044:Regression Analysis; D012307:Risk Factors; D014546:Urinary Catheterization; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems