European Geriatric Medicine - Supplement 1 - Volume 6

S116

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. Pressel

, M. Lillevang-Johannsen

, M. Gamwell Dawids

E. Jimenez Solem

, J. Dahl Knudsen

Bispebjerg Hospital, København NV, Denmark;

Bispebjerg Hospital,

Copenhagen, Denmark;

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 co-

infection 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

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. Schalck

, L. Henckaerts

, J. Verhaegen

, W. Peetermans

J. Flamaing

UZ Leuven, Leuven, Belgium;

Uz Leuven, Leuven, Belgium;

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%

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 PCV13-

serotypes 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

geriatric departments

R.-J. Schulz

, S. Langenfeld

, J. Wendel

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

S. Sch ¨utze

, A. Manig

, S. Ribes

, S. Bunkowski

, R. Nau

Department of Geriatics, Agaplesion Diakonie Kliniken, Frankfurt am

Main, Germany;

Institute of Neuropathology, University of G¨ottingen,

G¨ottingen, Germany;

Department of Geriatrics, Evangelisches

Krankenhaus G¨ottingen-Weende, G¨ottingen, Germany

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%