eprintid: 26597
rev_number: 15
eprint_status: archive
userid: 1589
dir: disk0/00/02/65/97
datestamp: 2019-08-09 10:26:14
lastmod: 2019-09-02 10:21:16
status_changed: 2019-08-09 10:26:14
type: article
metadata_visibility: show
creators_name: Beier, Dominik
creators_name: Weiß, Christel
creators_name: Hagmann, Michael
creators_name: Balaban, Ümniye
creators_name: Thiel, Manfred
creators_name: Schneider-Lindner, Verena
title: Is antibacterial treatment intensity lower in elderly patients? A retrospective cohort study in a German surgical intensive care unit
subjects: ddc-610
divisions: i-61600
divisions: i-911800
keywords: Antibacterials, ICU, Older patients, Electronic patient record, Zero-inflated Poisson regression
abstract: Background: Demographic change concurrent with medical progress leads to an increasing number of elderly patients in intensive care units (ICUs). Antibacterial treatment is an important, often life-saving, aspect of intensive care but burdened by the associated antimicrobial resistance risk. Elderly patients are simultaneously at greater risk of infections and may be more restrictively treated because, generally, treatment intensity declines with age. We therefore described utilization of antibacterials in ICU patients older and younger than 80 years and examined differences in the intensity of antibacterial therapy between both groups.

Methods: We analysed 17,464 valid admissions from the electronic patient data management system of our surgical ICU from April 2006 – October 2013. Antibacterial treatment rates were defined as days of treatment (exposed patient days) relative to patient days of ICU stay and calculated for old and young patients. Rates were compared in zero-inflated Poisson regression models adjusted for patients’ sex, mean SAPS II- and TISS-scores, and calendar years yielding adjusted rate ratios (aRRs). Rate ratios exceeding 1 represent higher rates in old patients reflecting greater treatment intensity in old compared to younger patients.

Results: Observed antibacterial treatment rates were lower in patients 80 years and older compared to younger patients (30.97 and 39.73 exposed patient days per 100 patient days in the ICU, respectively). No difference in treatment intensity, however, was found from zero-inflated Poisson regression models permitting more adequate consideration of patient days with low treatment probability: for all antibacterials the adjusted rate ratio (aRR) was 1.02 (95%CI: 0.98–1.07). Treatment intensities were higher in elderly patients for penicillins (aRR 1.37 (95%CI: 1.26–1.48)), cephalosporins (aRR 1.20 (95%CI: 1.09–1.31)), carbapenems (aRR 1.35 (95%CI: 1.20–1.50)), fluoroquinolones (aRR 1.17 (95%CI: 1.05–1.30), and imidazoles (aRR 1.34 (95%CI: 1.23–1.46)).

Conclusions: Elderly patients were generally less likely to be treated with antibacterials. This observation, however, did not persist in patients with comparable treatment probability. In these, antibacterial treatment intensity did not differ between younger and older ICU patients, for some antibacterial classes treatment intensity was even higher in the latter. Patient-level covariates are instrumental for a nuanced evaluation of age-effects in antibacterial treatment in the ICU.
date: 2019
publisher: BioMed Central
id_scheme: DOI
ppn_swb: 1675685630
own_urn: urn:nbn:de:bsz:16-heidok-265979
language: eng
bibsort: BEIERDOMINISANTIBACT2019
full_text_status: public
publication: BMC Health Services Research
volume: 19
number: 367
place_of_pub: London
pagerange: 1-9
issn: 1472-6963
citation:   Beier, Dominik ; Weiß, Christel ; Hagmann, Michael ; Balaban, Ümniye ; Thiel, Manfred ; Schneider-Lindner, Verena  (2019) Is antibacterial treatment intensity lower in elderly patients? A retrospective cohort study in a German surgical intensive care unit.  BMC Health Services Research, 19 (367).  pp. 1-9.  ISSN 1472-6963     
document_url: https://archiv.ub.uni-heidelberg.de/volltextserver/26597/1/12913_2019_Article_4204.pdf