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Variation in Mortality Rates Among Long-Term Care Facilities for Residents With Lower Respiratory Tract Infection

Published online by Cambridge University Press:  02 January 2015

L. E. Nicolle ,
S. Mubareka ,
A. Simor ,
B. Liu ,
S. McNeil ,
D. Lewis ,
H. Duckworth ,
M. Cheang  and
M. Loeb
L. E. Nicolle*
Affiliation:
Departments of Medical Microbiology, University of Manitoba, Winnipeg Department of Internal Medicine, University of Manitoba, Winnipeg
S. Mubareka
Affiliation:
Departments of Medical Microbiology, University of Manitoba, Winnipeg Department of Internal Medicine, University of Manitoba, Winnipeg
A. Simor
Affiliation:
Departments of Microbiology, University of Toronto, Toronto
B. Liu
Affiliation:
Geriatric Medicine, University of Toronto, Toronto
S. McNeil
Affiliation:
Department of Internal Medicine, Dalhousie University, Halifax
D. Lewis
Affiliation:
St. Joseph's Health Care System Research Network, Hamilton, Canada
H. Duckworth
Affiliation:
Departments of Medical Microbiology, University of Manitoba, Winnipeg
M. Cheang
Affiliation:
Community Health Sciences, University of Manitoba, Winnipeg
M. Loeb
Affiliation:
Hamilton Regional Laboratory Medicine, McMaster University, Hamilton, Canada
*
Departments of Internal Medicine and Medical Microbiology, University of Manitoba Health Sciences Centre, Rm. GG443, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada (lnicolle@hsc.mb.ca.)
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Abstract

Objective.

To identify variables contributing to interfacility differences in mortality among residents of long-term care facilities who have lower respiratory tract infection.

Design.

Multicenter, prospective, 1 -year observational study.

Setting.

Twenty-one long-term care facilities in 4 geographic areas of Canada.

Participants.

Residents of long-term care facilities prescribed antimicrobials for treatment of lower respiratory tract infection.

Methods.

Mortality rates were calculated for 3 definitions of lower respiratory tract infection: episodes with a clinical or radiographic diagnosis and treated with antimicrobials (definition 1); episodes with a physician diagnosis of pneumonia (definition 2); and episodes with chest radiography findings consistent with pneumonia (definition 3). Multilevel modeling was used to evaluate variables describing premorbid resident status, clinical presentation, management, and facility characteristics. Multivariable models were developed to identify independent predictors of mortality and determine whether facility-level variables remained independently associated with mortality rate after incorporation of individual-level variables.

Results.

Facility mortality rates varied from 0% to 17.8% for definition 1, from 0% to 47.1% for definition 2, and from 0% to 37.5% for definition 3. There were significant differences in mortality rate depending on which definition was used; for definitions 1 and 2, there were significant differences in mortality rate across facilities. Poorer premorbid resident status and a more severe presentation remained independent predictors of mortality in the multivariable analysis. There were also significantly increased mortality rates for episodes in which a fluoroquinolone was prescribed for initial treatment. For definitions 1 and 3, facility-level variables remained independently associated with mortality rate in the final multivariable model.

Conclusions.

Rates of mortality due to lower respiratory tract infection varied among long-term care facilities and differed within a facility, depending on the definition applied. Variables describing premorbid resident status, severity of presentation, and management did not fully explain the variation in mortality rate. Some facility-level variables remained independent predictors of mortality.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 8 , August 2008 , pp. 754 - 759
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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References

1.Nicolle, LE, Strausbaugh, LJ, Garibaldi, RA. Infections and antibiotic resistance in nursing homes. Clin Microbiol Rev 1996;9:1–17.CrossRefGoogle ScholarPubMed
2.Stevenson, KB, Moore, J, Colwell, H, Sleeper, B. Standardized infection surveillance in long-term care: interfacility comparisons from a regional cohort of facilities. Infect Control Hosp Epidemiol 2005;26:231–238.Google Scholar
3.Mylotte, JM. Nursing home-associated pneumonia. Clin Geriatr Med 2007;23:553–565, vi.CrossRefGoogle ScholarPubMed
4.Naughton, BJ, Mylotte, JM, Tayara, A. Outcome of nursing-home acquired pneumonia: deviation and application of a practical model to predict 30 day mortality. J Am Geriatr Soc 2000;48:1292–1299.Google Scholar
5.Mehr, DR, Zweig, SC, Kruse, RL, et al.Mortality from lower respiratory infection in nursing home residents. J Fam Pract 1998;47:298–304.Google Scholar
6.Mehr, DR, Foxman, B, Colombo, P. Risk factors for mortality for lower respiratory infections in nursing home patients. J Fam Practice 1992;34:585–591.Google Scholar
7.Loeb, M, Simor, AE, Landry, L, McGeer, A. Adherence to antibiotic guidelines for pneumonia in chronic-care facilities in Ontario. Clin Invest Med 2001;24:304–310.Google Scholar
8.Muder, RR, Brennen, C, Swenson, DL, Wagener, M. Pneumonia in a long term care facility. Arch Intern Med 1996;156:2365–2370.CrossRefGoogle ScholarPubMed
9.Mehr, DR, Binder, EF, Kruse, RL, et al.Predicting mortality in nursing home residents with lower respiratory tract infection. JAMA 2001;286:2427–2436.Google Scholar
10.Vergis, EN, Brennen, C, Wagener, M, Muder, RR. Pneumonia in long-term care. Arch Intern Med 2001;161:2378–2381.CrossRefGoogle ScholarPubMed
11.van der Steen, JT, Mehr, DR, Kruse, RL, et al.Predictors of mortality for lower respiratory infections in nursing home residents with dementia were validated transnationally. J Clin Epidemiol 2006;59:970–979.Google Scholar
12.Mubareka, S, Duckworth, H, Cheang, M, et al.Use of diagnostic tests for lower respiratory infection in long-term care facilities. J Am Ger Soc 2007;55:1365–1370.Google Scholar
13.Richards, C. Infections in residents of long term facilities: an agenda for research. Report of an expert panel. J Am Geriatr Soc 2002;50:570–576.Google Scholar
14.Mandell, LA, Wunderink, RG, Anzueto, A, et al.Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44(Suppl 2):S27-S72.Google Scholar
15.Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388–416.CrossRefGoogle Scholar
16.SHEA Long Term Care Committee. Nicolle, LE, Bentley, D, Garibaldi, R, Neuhaus, E, Smith, P, Antimicrobial use in long-term care facilities. Infect Control Hosp Epidemiol 2000;21:537–545.Google Scholar