Archive for October 14, 2016

Managing infective endocarditis in the elderly: new issues for an old disease.

Clin Interv Aging. 2016 Sep 2;11:1199-206.

Forestier E1, Fraisse T2, Roubaud-Baudron C3, Selton-Suty C4, Pagani L5.

Author information

1Infectious Diseases Department, Centre Hospitalier Métropole Savoie, Chambéry, France.

2Acute Geriatric Department, Centre Hospitalier, Alès, France.

3Geriatric Department, University Hospital, Bordeaux, France.

4Department of Cardiology, University Hospital, Nancy, France.

5Infectious Diseases Department, Centre Hospitalier Annecy-Genevois, Annecy, France.

Abstract

The incidence of infective endocarditis (IE) rises in industrialized countries.

Older people are more affected by this severe disease, notably because of the increasing number of invasive procedures and intracardiac devices implanted in these patients.

Peculiar clinical and echocardiographic features, microorganisms involved, and prognosis of IE in elderly have been underlined in several studies.

Additionally, elderly population appears quite heterogeneous, from healthy people without past medical history to patients with multiple diseases or who are even bedridden.

However, the management of IE in this population has been poorly explored, and international guidelines do not recommend adapting the therapeutic strategy to the patient’s functional status and comorbidities.

Yet, if IE should be treated according to current recommendations in the healthiest patients, concerns may rise for older patients who suffer from several chronic diseases, especially renal failure, and are on polypharmacy.

Treating frailest patients with high-dose intravenous antibiotics during a prolonged hospital stay as recommended for younger patients could also expose them to functional decline and toxic effect. Likewise, the place of surgery according to the aging characteristics of each patient is unclear.

The aim of this article is to review the recent data on epidemiology of IE and its peculiarities in the elderly.

Then, its management and various therapeutic approaches that can be considered according to and beyond guidelines depending on patient comorbidities and frailty are discussed.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015881/pdf/cia-11-1199.pdf

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October 14, 2016 at 3:55 pm

Receipt of Antibiotics in Hospitalized Patients and Risk for Clostridium difficile Infection in Subsequent Patients Who Occupy the Same Bed

JAMA – Internal Medicine October 10, 2016

Daniel E. Freedberg, MD, MS1; Hojjat Salmasian, MD, PhD2; Bevin Cohen, MPH3; et al

1Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York

2Department of Biomedical Informatics, New York-Presbyterian Hospital, New York, New York

3Department of Epidemiology, Mailman School of Public Health, School of Nursing, Columbia University, New York, New York

abstract

Objective 

To assess whether receipt of antibiotics by prior hospital bed occupants is associated with increased risk for CDI in subsequent patients who occupy the same bed.

Design, Setting, and Participants 

This is a retrospective cohort study of adult patients hospitalized in any 1 of 4 facilities between 2010 and 2015. Patients were excluded if they had recent CDI, developed CDI within 48 hours of admission, had inadequate follow-up time, or if their prior bed occupant was in the bed for less than 24 hours.

Main Outcomes and Measures 

The primary exposure was receipt of non-CDI antibiotics by the prior bed occupant and the primary outcome was incident CDI in the subsequent patient to occupy the same bed. Incident CDI was defined as a positive result from a stool polymerase chain reaction for the C difficile toxin B gene followed by treatment for CDI. Demographics, comorbidities, laboratory data, and medication exposures are reported.

Results 

Among 100 615 pairs of patients who sequentially occupied a given hospital bed, there were 576 pairs (0.57%) in which subsequent patients developed CDI. Receipt of antibiotics in prior patients was significantly associated with incident CDI in subsequent patients (log-rank P < .01). This relationship remained unchanged after adjusting for factors known to influence risk for CDI including receipt of antibiotics by the subsequent patient (adjusted hazard ratio [aHR], 1.22; 95% CI, 1.02-1.45) and also after excluding 1497 patient pairs among whom the prior patients developed CDI (aHR, 1.20; 95% CI, 1.01-1.43). Aside from antibiotics, no other factors related to the prior bed occupants were associated with increased risk for CDI in subsequent patients.

Conclusions and Relevance 

Receipt of antibiotics by prior bed occupants was associated with increased risk for CDI in subsequent patients. Antibiotics can directly affect risk for CDI in patients who do not themselves receive antibiotics.

FULL TEXT (NO PDF)

http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2565687

October 14, 2016 at 8:15 am


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