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P-318: The impact of childhood 13-valent pneumococcal conjugate vaccination on overall invasive pneumococcal disease, including the oldest old
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Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
urinary tract. Elderly patients does not present with classical signs and symptoms. If initial treatment is not working we have to look elsewhere. If patient is not suitable for surgical intervention we should look into alternative options. P-317 Are there any risk factors for VRE-colonization in geriatric patients: A case–control study E. Pressel1 , M. Lillevang-Johannsen2 , M. Gamwell Dawids2 , E. Jimenez Solem2 , J. Dahl Knudsen3 1 Bispebjerg Hospital, København NV, Denmark; 2 Bispebjerg Hospital, Copenhagen, Denmark; 3 Hvidovre Hospital, Hvidovre, Denmark Objectives: Colonization with vancomycine resistant Enterococcus faecium (VRE) has been an emerging and cost-intensive problem during the past years. Transmission pathway is faeco-orally, exposure time and close contact to colonized patients are thought to be important risk factors. The aim of this study was to show possible clinical risk factors for VRE-colonization in geriatric patients and to explore antibiotic use and coinfection rates with Clostridium difficile (CD). Methods: In a retrospective case-control study we included all patients admitted to the geriatric department between May and August 2013 (n = 122), defined as cases (n = 38) or controls (n = 84) depending on their rectal VRE colonization status during hospitalization. Clinical data, functional status (ADL), readmission and death rates, data on antibiotic use 6 months prior to study period and coinfection rate with CD 6 months before and after study period, were collected. Results: Readmission rates (p < 0.01) and length of hospital stay were higher in cases (p = 0.03), no significant differences in mortality rates were observed. We found more co-infections with CD in the case group (p < 0.01) and a higher use of amoxicilline/clavulanate and ciprofloxacin (p < 0.05). No significant difference in the use of other antimicrobial agents was observed. No differences in age, sex, functional status and Charlsons Comorbidity Index were found. Conclusion: VRE-colonized geriatric patients are characterized by high readmission rates, long hospital stay and high coinfection rates with CD. Clinical factors seem to play a minor role suggesting that minimizing exposure is the most efficient strategy to avoid VRE colonization also in these patients. P-318 The impact of childhood 13-valent pneumococcal conjugate vaccination on overall invasive pneumococcal disease, including the oldest old N. Schalck1 , L. Henckaerts2 , J. Verhaegen2 , W. Peetermans2 , J. Flamaing3 1 UZ Leuven, Leuven, Belgium; 2 Uz Leuven, Leuven, Belgium; 3 Department of Geriatric Medicine University Hospitals Leuven and KU Leuven, Leuven, Belgium Objectives: The aim of this study was to compare serotype distribution in invasive pneumococcal disease (IPD) in the Belgian population before and after the introduction of the 13-valent conjugate vaccine (PCV13) in the national childhood vaccination schedule. Methods: Serotyping was performed on 9787 pleural fluid and bacteraemic isolates (IPD-isolates) sent to the National Reference Laboratory between 2008 and 2014. We compared the distribution of serotypes (ST) /serogroups (SG) between the periods before (2008–2010) and after (2012–2014) the introduction of PCV13 in children and adults of different age groups, including older individuals (65–84 and >85 years).
Results: The introduction of PCV13 in the childhood immunisation program resulted in a reduction of 16% of all IPD-isolates. The prevalence of PCV13-SG decreased in all age groups. A decrease from 79% to 59% (p < 0.005) was seen in children <18 years and from 67% to 57% (p < 0.005) in persons aged 18–64. This effect was also observed in older persons, with a decline from 63% to 54% (p < 0.005) and 61% to 51% (p < 0.005) in the age groups 65–84 and >85 years, respectively. Furthermore, we observed a significant reduction in coverage rate for the 23-valent polysaccharide vaccine after introduction of PCV13 in all ages, except for those >85 years, where the coverage rate remains stable. Conclusions: After introduction of PCV13, a reduction of PCV13serotypes occurred in IPD in children, but also in other age groups, including those aged 65–84 and >85 years. This indirect effect (herd-protection) should be incorporated in the pneumococcal vaccine strategies for (older) adults. P-319 Risk management for patients with Clostridium difficile in geriatric departments R.-J. Schulz1 , S. Langenfeld1 , J. Wendel1 1 Department of Geriatric Medicine, St. Marien-Hospital, Cologne, Germany Objectives: Risk management of multimorbid patients has to take in consideration in terms of infection diseases like Clostridium difficile. The geriatric departments take over patients from other clinic departments to continue started therapies, especially antibiotic regiments. Methods: In a retrospective analyses patients were documented for allocation from other clinic departments or from acute ambulatory setting. This was performed as a monocentric clinical trial. Results: 2,826 patients were screened for Clostridium difficile associated diarrhoea transferred from 32 different clinical departments in 2014. 20% were allocated from an ambulatory setting. In 167 cases the clinical diagnose were documented and resulted in an extended treatment duration and complicated follow up. Antibiotic history was documented and indicated a high percentage of quinolone therapy. Conclusions: To avoid complicated follow up treatments and costly therapy strategies with an higher mortality risk, it will be necessary to document antibiotic history of geriatric patients and to perform a risk stratification supported by antibiotic stewardship. P-320 Course of Streptococcus pneumoniae meningitis in young and aged mice 1 S. Schutze ¨ , A. Manig2 , S. Ribes2 , S. Bunkowski2 , R. Nau3 Department of Geriatics, Agaplesion Diakonie Kliniken, Frankfurt am Main, Germany; 2 Institute of Neuropathology, University of G¨ ottingen, G¨ ottingen, Germany; 3 Department of Geriatrics, Evangelisches Krankenhaus G¨ ottingen-Weende, G¨ ottingen, Germany
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Objectives: In order to elucidate the causes for the increased incidence and mortality of aged patients with bacterial central nervous system (CNS) infections, we compared the course of Streptococcus pneumoniae meningitis in aged and young mice. Methods: Aged (21.2+3.1 months, n = 40) and young (3.2+0.9 months, n = 42) C57BL/6N and B6/SJL mice were infected by intracerebral injection of 50–70 CFU S. pneumonia SP3 and monitored for 15 days (clinical score, motor functions, weight). Bacterial concentrations in cerebellum and spleen were determined by quantitative plating [median (25./75. percentile) CFU/ml]. Leukocytes were quantified in brain sections stained by chloracetate-esterase [meningeal inflammation score: median (25./75. percentile)]. Results: After intracerebral infection with S. pneumonia, aged and young mice did not differ concerning mortality (35%
Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
urinary tract. Elderly patients does not present with classical signs and symptoms. If initial treatment is not working we have to look elsewhere. If patient is not suitable for surgical intervention we should look into alternative options. P-317 Are there any risk factors for VRE-colonization in geriatric patients: A case–control study E. Pressel1 , M. Lillevang-Johannsen2 , M. Gamwell Dawids2 , E. Jimenez Solem2 , J. Dahl Knudsen3 1 Bispebjerg Hospital, København NV, Denmark; 2 Bispebjerg Hospital, Copenhagen, Denmark; 3 Hvidovre Hospital, Hvidovre, Denmark Objectives: Colonization with vancomycine resistant Enterococcus faecium (VRE) has been an emerging and cost-intensive problem during the past years. Transmission pathway is faeco-orally, exposure time and close contact to colonized patients are thought to be important risk factors. The aim of this study was to show possible clinical risk factors for VRE-colonization in geriatric patients and to explore antibiotic use and coinfection rates with Clostridium difficile (CD). Methods: In a retrospective case-control study we included all patients admitted to the geriatric department between May and August 2013 (n = 122), defined as cases (n = 38) or controls (n = 84) depending on their rectal VRE colonization status during hospitalization. Clinical data, functional status (ADL), readmission and death rates, data on antibiotic use 6 months prior to study period and coinfection rate with CD 6 months before and after study period, were collected. Results: Readmission rates (p < 0.01) and length of hospital stay were higher in cases (p = 0.03), no significant differences in mortality rates were observed. We found more co-infections with CD in the case group (p < 0.01) and a higher use of amoxicilline/clavulanate and ciprofloxacin (p < 0.05). No significant difference in the use of other antimicrobial agents was observed. No differences in age, sex, functional status and Charlsons Comorbidity Index were found. Conclusion: VRE-colonized geriatric patients are characterized by high readmission rates, long hospital stay and high coinfection rates with CD. Clinical factors seem to play a minor role suggesting that minimizing exposure is the most efficient strategy to avoid VRE colonization also in these patients. P-318 The impact of childhood 13-valent pneumococcal conjugate vaccination on overall invasive pneumococcal disease, including the oldest old N. Schalck1 , L. Henckaerts2 , J. Verhaegen2 , W. Peetermans2 , J. Flamaing3 1 UZ Leuven, Leuven, Belgium; 2 Uz Leuven, Leuven, Belgium; 3 Department of Geriatric Medicine University Hospitals Leuven and KU Leuven, Leuven, Belgium Objectives: The aim of this study was to compare serotype distribution in invasive pneumococcal disease (IPD) in the Belgian population before and after the introduction of the 13-valent conjugate vaccine (PCV13) in the national childhood vaccination schedule. Methods: Serotyping was performed on 9787 pleural fluid and bacteraemic isolates (IPD-isolates) sent to the National Reference Laboratory between 2008 and 2014. We compared the distribution of serotypes (ST) /serogroups (SG) between the periods before (2008–2010) and after (2012–2014) the introduction of PCV13 in children and adults of different age groups, including older individuals (65–84 and >85 years).
Results: The introduction of PCV13 in the childhood immunisation program resulted in a reduction of 16% of all IPD-isolates. The prevalence of PCV13-SG decreased in all age groups. A decrease from 79% to 59% (p < 0.005) was seen in children <18 years and from 67% to 57% (p < 0.005) in persons aged 18–64. This effect was also observed in older persons, with a decline from 63% to 54% (p < 0.005) and 61% to 51% (p < 0.005) in the age groups 65–84 and >85 years, respectively. Furthermore, we observed a significant reduction in coverage rate for the 23-valent polysaccharide vaccine after introduction of PCV13 in all ages, except for those >85 years, where the coverage rate remains stable. Conclusions: After introduction of PCV13, a reduction of PCV13serotypes occurred in IPD in children, but also in other age groups, including those aged 65–84 and >85 years. This indirect effect (herd-protection) should be incorporated in the pneumococcal vaccine strategies for (older) adults. P-319 Risk management for patients with Clostridium difficile in geriatric departments R.-J. Schulz1 , S. Langenfeld1 , J. Wendel1 1 Department of Geriatric Medicine, St. Marien-Hospital, Cologne, Germany Objectives: Risk management of multimorbid patients has to take in consideration in terms of infection diseases like Clostridium difficile. The geriatric departments take over patients from other clinic departments to continue started therapies, especially antibiotic regiments. Methods: In a retrospective analyses patients were documented for allocation from other clinic departments or from acute ambulatory setting. This was performed as a monocentric clinical trial. Results: 2,826 patients were screened for Clostridium difficile associated diarrhoea transferred from 32 different clinical departments in 2014. 20% were allocated from an ambulatory setting. In 167 cases the clinical diagnose were documented and resulted in an extended treatment duration and complicated follow up. Antibiotic history was documented and indicated a high percentage of quinolone therapy. Conclusions: To avoid complicated follow up treatments and costly therapy strategies with an higher mortality risk, it will be necessary to document antibiotic history of geriatric patients and to perform a risk stratification supported by antibiotic stewardship. P-320 Course of Streptococcus pneumoniae meningitis in young and aged mice 1 S. Schutze ¨ , A. Manig2 , S. Ribes2 , S. Bunkowski2 , R. Nau3 Department of Geriatics, Agaplesion Diakonie Kliniken, Frankfurt am Main, Germany; 2 Institute of Neuropathology, University of G¨ ottingen, G¨ ottingen, Germany; 3 Department of Geriatrics, Evangelisches Krankenhaus G¨ ottingen-Weende, G¨ ottingen, Germany
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Objectives: In order to elucidate the causes for the increased incidence and mortality of aged patients with bacterial central nervous system (CNS) infections, we compared the course of Streptococcus pneumoniae meningitis in aged and young mice. Methods: Aged (21.2+3.1 months, n = 40) and young (3.2+0.9 months, n = 42) C57BL/6N and B6/SJL mice were infected by intracerebral injection of 50–70 CFU S. pneumonia SP3 and monitored for 15 days (clinical score, motor functions, weight). Bacterial concentrations in cerebellum and spleen were determined by quantitative plating [median (25./75. percentile) CFU/ml]. Leukocytes were quantified in brain sections stained by chloracetate-esterase [meningeal inflammation score: median (25./75. percentile)]. Results: After intracerebral infection with S. pneumonia, aged and young mice did not differ concerning mortality (35%