RESUMEN
BACKGROUND: Urinary tract infections (UTIs), often sustained by polymicrobial flora (p-UTIs), are a common finding among nursing home patients, and associated with adverse outcomes and increased healthcare costs. P-UTIs have been extensively studied with regard to microbiological aspects. However, little is known about the characteristics of the host. AIMS: The aim of this study is to verify to which extent comorbidity characterizes elderly nursing home patients with p-UTIs. METHODS: We enrolled 299 patients with culture-positive UTI consecutively admitted to the nursing home of the "Fondazione San Raffaele Cittadella della Carità", Taranto, Italy. P-UTI was diagnosed when two uropathogens were simultaneously isolated. The burden of comorbidity was quantified using the Charlson comorbidity score index. Logistic regression analysis was used to assess the adjusted association of the variables of interest with the presence of p-UTI. RESULTS: P-UTIs were detected in 118/299 (39%) patients. According to logistic regression, the presence of p-UTIs was independently associated with the Charlson index (OR 1.70; 95% CI 1.06-2.72; P = .026). This association remained also after excluding participants without urinary catheter (OR 1.88; 95% CI 1.13-3.11; P = .015). DISCUSSION: The presence of P-UTIs is associated with the burden of comorbidity, but not with individual diseases. CONCLUSIONS: Older nursing home patients with comorbidity should be screened for the presence of p-UTIs; further studies are needed to evaluate the impact of early detection and treatment of p-UTIs on the development of comorbidity.
Asunto(s)
Coinfección , Costo de Enfermedad , Institucionalización/estadística & datos numéricos , Infecciones Urinarias , Anciano , Anciano de 80 o más Años , Coinfección/diagnóstico , Coinfección/epidemiología , Coinfección/fisiopatología , Comorbilidad , Femenino , Hogares para Ancianos/estadística & datos numéricos , Humanos , Italia/epidemiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Casas de Salud/estadística & datos numéricos , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/epidemiología , Infecciones Urinarias/microbiología , Infecciones Urinarias/fisiopatologíaRESUMEN
OBJECTIVES: 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.
Asunto(s)
Antibacterianos/uso terapéutico , Carbapenémicos/uso terapéutico , Resistencia a Medicamentos , Infecciones Urinarias/tratamiento farmacológico , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Casas de Salud , Transferencia de Pacientes , Análisis de Regresión , Factores de Riesgo , Cateterismo Urinario , Infecciones Urinarias/mortalidadRESUMEN
BACKGROUND: Heart failure (HF) is frequently complicated by malnutrition. We estimated nutrient intake in HF patients and evaluated the correlation between serum cytokines and dietary pattern. METHODS: We studied 124 elderly (>or=60 years) patients with severe HF (N=62) or without HF (controls, N=62), matched for age and sex. Nutritional data were obtained from the European Prospective Investigation into Cancer and Nutrition (EPIC) questionnaire. We compared the intake of macro- and micronutrients in the two groups; in the HF group nutritional intake was correlated with serum cytokines. RESULTS: HF patients had a lower energy intake (26.8 Kcal/Kg of ideal weight vs. 37.3 Kcal /Kg ideal weight in controls, P<0.001) due to a lower intake of all macronutrients. The energy intake was lower than the recommended (30 Kcal/Kg of ideal body weight) in 72% of HF and 34% of the controls. The intake of several minerals and vitamins was inferior to the recommended dietary allowance (RDA) in most participants. Those HF patients with a caloric intake below the median (22.6 Kcal/Kg ideal weight) did not differ substantially from those with higher caloric intake with regard to age, functional characteristics, and lean body mass as expressed by the mid-arm muscle circumference, however, they had a higher concentration of IL4 (61.5 pg/ml vs. 37.7 pg/ml, P=0.075) and of IL10 (6.32 pg/ml vs. 2.06 pg/ml, P=0.046). CONCLUSIONS: Nutritional intake is frequently inadequate in patients with severe HF. Our results suggest that some interleukins might affect caloric intake in patients with HF.