title: The Burden of Comorbidity Is Associated with Antibiotic Resistance Among Institutionalized Elderly with Urinary Infection: A Retrospective Cohort Study in a Single Italian Nursing Home Between 2009 and 2014.
abstract: Urinary tract infections (UTIs), which are common among nursing home patients, are associated with adverse outcomes and increased healthcare costs. Antibiotic resistance is an emerging problem, associated with excess morbidity and mortality; it has been suggested that this condition might be more prevalent among subjects with comorbid conditions. The aim of this study was to assess the association, if any, of antibiotic resistance with the burden of comorbidity in elderly with UTIs. This retrospective study enrolled 299 patients with culture-positive UTI consecutively admitted to the nursing home of the "Fondazione San Raffaele Cittadella della Carità", Taranto, Italy, which includes 80 beds under the direction of two geriatricians. The burden of comorbidity was quantified using the Charlson comorbidity score index. Diagnosis of UTI was ascertained by urine culture. Antibiotic resistance was defined according to the European Centre for Disease Prevention and Control expert proposal. Logistic regression was used to assess the adjusted association of the variables of interest with the presence of antibiotic resistance. Antibiotic resistance was detected in 162/299 (54%) patients. In logistic regression, the presence of antibiotic resistance was independently associated with higher Charlson score, after adjusting (odds ratio = 1.06; 95% confidence interval = 1.01-1.10). Antibiotic resistance is highly prevalent among nursing home residents; it is associated with the burden of comorbidity, but not with single diseases. This association and its potential implications should be assessed in dedicated studies.
authors.affiliation: 1 Unit of Geriatrics, Department of Medicine, Campus Bio-Medico di Roma University , Rome, Italy .
authors.forename: Alice
authors.initials: A
authors.lastname: Laudisio
authors.affiliation: 2 Fondazione San Raffaele-Cittadella della Carità , Taranto, Italy .
authors.forename: Felice
authors.initials: F
authors.lastname: Marinosci
authors.affiliation: 3 UOS Accesso e Presa in Carico Assistenziale, Azienda Sanitaria Locale Roma E , Rome, Italy .
authors.forename: Antonella
authors.initials: A
authors.lastname: Gemma
authors.affiliation: 1 Unit of Geriatrics, Department of Medicine, Campus Bio-Medico di Roma University , Rome, Italy .
authors.forename: Isaura Rossi
authors.initials: IR
authors.lastname: Bartoli
authors.affiliation: 1 Unit of Geriatrics, Department of Medicine, Campus Bio-Medico di Roma University , Rome, Italy .|2 Fondazione San Raffaele-Cittadella della Carità , Taranto, Italy .
authors.forename: Nicola
authors.initials: N
authors.lastname: Montenegro
authors.affiliation: 1 Unit of Geriatrics, Department of Medicine, Campus Bio-Medico di Roma University , Rome, Italy .|2 Fondazione San Raffaele-Cittadella della Carità , Taranto, Italy .
authors.forename: Raffaele Antonelli
authors.initials: RA
authors.lastname: Incalzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D015897:Comorbidity; D003704:Dementia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D004352:Drug Resistance, Microbial / Q000235:genetics*; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D006620:Hip Fractures / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006707:Homes for the Aged; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007709:Klebsiella / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D008297:Male; D009735:Nursing Homes; D003668:Pressure Ulcer / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D011511:Proteus / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic resistance; comorbidity; epidemiology; nursing home; urinary infection