180 / 290
Results:
Influenza:
≈
38,500 deaths estimated to occur each year in the
EU/EEA countries with 90% in seniors. In France, during 2014
–
15
season,
≈
30,000 cases admitted to intensive care units for influenza
resulting in 3133 hospitalisations (47% in 65+) and excess all-cause
mortality of 18,300 individuals (90% in 65+) reported. Same trend
in most EU countries. Pneumococcal diseases: 20,785 confirmed
cases of invasive pneumococcal disease reported by 27 EU/EEA
countries in 2012, predominantly in seniors. Zoster: more than 1.7
million new cases all ages each year in Europe, risk and severity
increasing with age. Diphteria: in 2012, 27 cases of diphtheria reported
by 8 EU/EEA countries, the majority being in seniors. Tetanus: In 2012,
123 cases reported, 80% in seniors. Pertussis: in 2012, 42,525 cases
reported by 28 EU/EEA countries. Incidence is increasing in adoles-
cents and adults and gives reasons for concern of transmission to
infants. Polio: no case in any of the 29 reporting EU/EEA countries
in 2012.
Conclusions:
With an ageing European population, these data support
a strong public health rationale for preventing influenza, pneumococ-
cal diseases and zoster in seniors, all these diseases being of higher and
substantial incidence and severity in this age group.
P-549
Gastrointestinal infections and the use of proton pump inhibitors
in a geriatric population
I. Figueiredo, G. Magalhães, A.M. Antunes, H. Gruner, A. Panarra.
Serviço Medicina 7.2
–
Hospital Curry Cabral, CHLC
Gastroenteritis (GE) has a high case-fatality ratio in the elderly . It is
associated with nursing homes and antibiotics , but chronic use of
proton pump inhibitors (PPI) has also been related to it. One of the
major adverse effects is dehydration, predisposed by atherosclerosis,
but increased mortality should also be considered . A retrospective
descriptive study was carried out, including patients admitted to a
medical ward with the diagnosis of GE, during a 5-year-period.
Patients were characterised according to gender, age and Charlson
Comorbity Index (CCI). The endpoints were PPI use, previous use of
antibiotics, antibiotic given for GE, dehydration, intensive care unit
(ICU) admission, mortality and readmission at 1 month. During this
period, 96 patients were admitted. 58% were female, with an average
age of 81.03 years. Male patients had an average age of 78.35 years and
a higher CCI (7.6 vs 5.8 for females; 6.6 global). More than half (55%)
used PPI chronically and 15% had been previously treated with
antibiotics. An agent was identified in only 6.25%, but 45% were treated
with antibiotics: ciprofloxacin (39%), cephalosporins (25%), metro-
nidazole (18%), amoxicillin (9%), vancomycin (7%), macrolides (6.7%)
and piperacillin/tazobactam (4.5%). Dehydration was present in 60% of
patients, 3% needed ICU admission, 5% died and 15% were readmitted
in the following month. Our results are similar to previous studies,
which demonstrates the importance of PPI and antibiotics use before
acute GE. The extensive use of antibiotics in this setting might be
counterproductive, as agents are seldom identified.
P-550
Healthcare resource utilization and costs associated with herpes
zoster in the United States
B.H. Johnson
1
, L. Palmer
1
, J. Gatwood
2
, G. Lenhart
1
, K. Kawai
3
, K.
D. Johnson
4
, C.J. Acosta
4
.
1
Truven Health Analytics, Boston, MA,
2
University of Tennessee, Knoxville, TN,
3
Harvard Medical School, Boston,
MA,
4
Merck & Co., Inc., Center for Observational and Real World Evidecnce
(CORE), Kenilworth, NJ, USA
Background:
Herpes zoster continues to have a significant financial
impact on the U.S. healthcare system. The objective of this study was to
evaluate the economic burden of herpes zoster (HZ) on the US
healthcare system among an immunocompetent population.
Methods:
Claims data from the MarketScan
®
Research databases for
2008
–
2011 were extracted to determine the incremental healthcare
resource utilization (RU) and direct medical costs associated with HZ.
Immunocompetent HZ-patients were identified and directly matched
1:1 with immunocompetent non-HZ controls using demographic and
clinical variables. Analysis was limited to claims 21 days prior to
through the first year following HZ diagnosis. Cases with post-herpetic
neuralgia (PHN) were analyzed separately.
Results:
In total, 98,916 HZ-patients were matched to controls. HZ-
patients had a mean age of 50.4 (SD: 18.8) years and 56.6% were
females. HZ-cases had significantly higher RU (0.016 inpatient visits,
0.153 ER visits, 2.116 outpatient office visits and 3.730 other outpatient
services) compared to controls (p < 0.001). Differences increased
substantially in the presence of PHN. Total mean incremental
healthcare costs for HZ-cases were $1,308 and quadrupled to $5,463
in those with PHN (both p < 0.001). Overall, primary cost drivers were
outpatient prescriptions and other outpatient services. For those with
PHN, inpatient services also played a significant role.
Conclusions:
HZ presents a significant economic and resource burden
on the US healthcare system among immunocompetent patients of
nearly all ages, particularly when complicated by PHN.
P-551
Infections in elderly patients
L. Jordanovski
1
, J. Jakimovska
1
, L. Neloska
1
.
1
PHI Gerontology Institute 13
November, Skopje, Republic of Macedonia
Objectives:
With the growth of elderly population we need to be
familiar with infectious diseases because they can increase mortality.
Thus is due to the changes in immune system, different epidemiology
and bacteriology and different clinical presentation of the infection.
The most common infections in adults are pneumonia, infections of
the urinary system, pressure ulcer, infectious diarrhoea, fever of
unknown origin etc. Viral infections are less common. During the
treatment we should use drugs which give fewer side effects in elderly
patients.
Methods:
We designed cross match study which aim was to show
types of infection and use of antibiotics in elderly patients during one
week in PHI Gerontology Institute 13 November as institution that
hospitalize patients aged over 65 with chronic progressive disease.
Results:
During one week in February in our hospital 234 patients
were hospitalized with an average age of 78 years, 34 patients (14.5%)
were diagnosed with infection mostly on the respiratory system
(55.9%), urinary system (20.6%), pressure ulcer (14.7%), digestive
system (5.9%). For treatment of this infectious most widely used
antibiotic were cephalosporines (43.3%), fluoroquinolones (22.8%),
sulphonamides (9.1%). 85% of the patients were on one antibiotic.
Conclusions:
In adult population we should take infections seriously
because some clinical evidence for occurrence of a disease can be
missing. Laboratory analyzes can show different variations in ESR, CRP
and leukocyte count. We need to take a good history and other clinical
investigations. We should use empirical antibiotic with broad
spectrum and few side effects.
P-552
Diabetes mellitus as risk factor for herpes zoster in United States
adults
C. Newransky
1
, J. Mao
2
, K. Kawai
3
, B. Gebremeskel
1
, J.T. McPheeters
2
,
K.D. Johnson
1
, C.J. Acosta
1
.
1
Merck Co. & Inc., Center for Observational
and Real World Evidence (CORE), Kenilworth, NJ,
2
Optum, Eden Prairie,
MN,
3
Harvard Medical School, Boston, MA, USA
Introduction:
Diabetes mellitus (DM) has been associated with an
increased risk of HZ. This study improves on previous research by using
a nationwide database to assess DM as a risk factor for HZ.
Methods:
Data for this retrospective cohort study was extracted
from commercial and Medicare Advantage plans in Optum claims
databases for adults aged
≥
18 who had at least 12 months of
continuous enrollment. The DM cohort consisted of enrollees with
≥
1 two claims with diagnosis code for diabetes (ICD-9-CM:
250.xx) in
2006
–
2011. Incident HZ cases were patients with
≥
1 claim with a
diagnosis code for HZ (ICD-9-CM: 053.0
–
053.11, 053.14
–
053.9) in any
position. Crude and adjusted HZ incidence by DM status and adjusted
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S174