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Oral presentations / European Geriatric Medicine 6S1 (2015) S5
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S31
treatment and 36 CDI-negative matched inpatients without
antibiotic were consecutively enrolled (107 subjects, 53 M,
age 81
±
9). A fecal sample was obtained for each participant
under controlled dietary regimen, and subsequently processed
for microbiota DNA extraction through a culture-independent
polymerase-chain reaction approach. Partial sequencing of 16S
rRNA gene and subsequent amplification were carried out to
allow DNA concentration calculation and taxonomic classification
of microbiota composition.
Results:
As compared to CDI-negative patients, in silico analyses
revealed a marked decrease in microbial diversity and species
richness in CDI-positive patients, mainly due to a paucity
of phylotypes within the Bacteroides phylum. The Firmicutes/
Bacteroides ratio was increased significantly in patients with CDI
but not in controls, possibly indicating a close association between
CDI and faecal microbiota dysbiosis. CDI was also associated to
depletion of normally abundant gut commensal organisms, such as
the Ruminococcaceae, Bacteroidaceae and Lachnospiraceae families.
In controls, antibiotic treatment was associated to a higher degree
of fecal microbiota dysbiosis than no-antibiotic group, although
much less significant than in CDI subjects.
Conclusions:
In hospitalized elderly, CDI development is associated
to significant alterations of gut microbiota composition. A better
understanding of these issues could prompt new strategies of
bacteriotherapy for both prevention and treatment of CDI.
All authors have no conflict of interest to declare.
O-046
Tolerance of subcutaneously administered antibiotics:
a national, prospective and observational study
C. Roubaud Baudron
1
, E. Forestier
2
, T. Fraisse
3
, J. Gaillat
4
,
L. Bernard
5
, L. Pagani
6
, G. Gavazzi
7
, M. Paccalin
8
1
CHU Hˆopitaux de Bordeaux, Bordeaux, France;
2
CH M´etropole Savoie,
Chamb´ery, France;
3
CH Al`es-C´evennes, Ales, France;
4
Division of
Infectious Diseases, Pringy, France;
5
CHU Tours, Tours, France;
6
CH
Annecy Genevois, Annecy, France;
7
University of Grenoble Alpes,
Grenoble, France;
8
CHU Poitiers, Poitiers, France
Objectives:
Subcutaneously (SC) antibiotic administration is
common in France. The aim of this study was to determine the
tolerance of such practice.
Methods:
Prospective non interventional multicenter study
including every adult patient treated at least one day with SC
antibiotic from May to September 2014. Occurrence of local and
systemic adverse effects (AE) and clinical evolution were collected
until the end of treatment.
Results:
216 patients (83 [19–104] yo) were included in 50 centers.
Ceftriaxone (n = 163 (74%)), ertapenem (n = 30 (14%)), teicoplanin
(n = 10) and other antibiotics (n = 15) were prescribed mainly for
urinary (n = 104 (48%)) and respiratory (n = 62 (28%)) infections. SC
route was used because of impossible intravenous or intramuscular
routes (65%), palliative care decision (32%), impossible oral route
(21%), absence of active oral antibiotic (21%), patient’s agitation
(21%), to facilitate hospital discharge (21%) and avoid hospitalization
(8%). 50 patients (23%) experimented at least one AE: pain (n = 29
(13%)), induration (n = 17 (8%)), erythema (n = 6 (3%)), hematoma
(16 (7%)). Systemic AE occurred in 5 (2%) patients. AE lead to an
increased hospital stay for 2 patients and a discontinuation of the SC
infusion (n = 6). They were more frequent when the antibiotic was
directly injected. No association was found with the prescription of
antithrombotic treatment. In over 80% of cases, SC antibiotic was
discontinued as planned and associated with a recovery.
Conclusions:
SC antibiotic administration leads to local but slight
reversible and benign AE. As It could be a safe alternative to
the IV route, more studies are needed regarding efficacy and
pharmacokinetics.
O-047
Norovirus-associated hospitalizations among older adults,
Germany 2007–2012
F. Kowalzik
1
, K. Frank
1
, M. Riera-Montes
2
, D. Z ¨oller
3
, R. Clemens
4
,
F. Zepp
1
, T. Verstraeten
2
1
University Medical Centre, Johannes Gutenberg University, Mainz,
Germany;
2
P95 Epidemiology and Pharmacovigilance Consulting
and Services, Leuven, Belgium;
3
Institute for Medical Biostatistics,
Epidemiology and Informatics, Johannes Gutenberg University, Mainz,
Germany;
4
Global Research in Infectious Diseases, Rio de Janeiro, Brazil
Objectives:
Noroviruses (NoVs) are the most important cause
globally of acute gastroenteritis (AGE) in all age groups, including
older adults. There is extensive, but not universal testing for NoV in
hospitalizations for AGE in Germany for cost reimbursement. Using
these data, we aimed to estimate the number of hospitalizations
for NoV AGE and the associated medical costs among the elderly in
Germany.
Methods:
The German Federal Statistics Office (DESTATIS) registers
all hospitalizations in Germany. Data for patients aged 65 years
and older hospitalized for AGE (ICD-10 codes A08-A09 as primary
diagnosis) were extracted for the period 2007–2012.
Results:
There were 301,869 hospitalizations among older adults
for AGE (primary diagnosis) in Germany during the study period, of
which 60,769 (20%) were associated with NoVs. The average annual
number of hospitalizations for NoV AGE among the 65+ age group
was 10,128, leading to an average annual incidence rate of 61 NoV
AGE hospitalizations per 100,000 older adults in Germany. The
total direct medical costs of NoV-associated hospitalizations was
€43,195,258 for the years 2007 to 2009, with an average annual
expenditure of €14,398,419.
Conclusions:
NoVs are an important cause of hospitalization among
older adults in Germany with a substantial financial burden in
direct medical costs. The incidence of hospitalization in this study is
higher than estimates in other European countries and similar to US
estimates. However, the number of NoV-associated hospitalizations
may be underestimated given use of primary ICD codes only and
the lack of routine NoV detection among older adults.
O-048
Vaccination and survival in a population of older adult living
in nursing home
A. Collamati
1
, F. Landi
2
, A. Poscia
3
, E. Topinkova
4
, R. Bernabei
5
,
G. Onder
5
1
Department of Gerontology, Orthopedics and Neuroscience. Catholic
University of Sacred Heart, Rome, Italy;
2
Catholic University of Sacred
Hearth, Rome, Italy;
3
Institute of Public Health, Catholic University of
Sacred Heart, Rome, Italy;
4
Czech Republic;
5
Italy
Objectives:
Influenza and pneumococcal vaccines have been proved
to be effective and safe in preventing and controlling infection
among elderly, reducing morbidity and mortality. For this reason,
in the last decades, influenza and pneumococcal vaccinations have
been commonly recommended for high-risk adults and older adult.
However, some evidences raised health concerns related to these
vaccinations. Aim of the present study is to identify prevalence
and outcomes related to influenza and pneumococcal vaccinations
in a large European population of frail and old people living in
nursing home.
Methods:
We conducted a cross-sectional analysis of nursing home
residents participating to the Services and Health for Elderly in
Long TERm care (SHELTER) project, a study collecting information
on residents admitted to 57 nursing home in 8 countries. Data
were collected using the interRAI instrument for long-term care
facilities. The impact of influenza and pneumococcal vaccination
was analyzed with Kaplan–Meier curve and adjusted Cox regression
analysis.