European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

182 / 290

group include the declining incidence of PCV13-serotype disease
in older adults secondary to infant immunizationwith PCV13, and lack
of evidence for cost effectiveness or effectiveness of a sequential
regimen.
Conclusions: To date none of the G20 countries with national funding
programs for pneumococcal vaccination of adults aged 65 and
older have adopted the change made by the US ACIP in 2014 for
this group. Reasons cited for this include the declining incidence of
PCV13-serotype disease in older adults, and lack of evidence for cost
effectiveness.
P-557
Infectious aortitis: a difficult diagnosis which requires a high level
of suspicion
P. Muhamed 1, S. Henneberg Pedersen1. 1Holbaek Hospital, Holbaek,
Denmark
Introduction: Infectious aortitis is a rare condition defined as
inflammation of the aorta caused by microorganisms. If left untreated
it can be lethal or complicated with development of aneurysms,
dissection, fistula or rupture of the aorta [1–3]. The aorta is normally
very resistant to infection [1]. Risk factors for infectous aortitis include
atherosclerosis, age above 50 years, trauma or aorta graft, impaired
immunity, diabetes mellitus, or congenital aortic anomalies [1, 2]. It is
a diagnosis that is difficult to make. Computed tomography (CT) is the
imaging study of choice in diagnosing infectious aortitis, however
small vegetations may be missed. Other diagnostic tools are Magnetic
resonance imaging (MRI) and Positron emission tomography (PET) CT
scan [1–3].
Methods and results: We present two cases, a 78 years old male
treated for E. coli and Pneumococcus septicaemia and a 71 years old
female treated for staphylococcus septicaemia. Their general condition
worsened despite of initial treatment with antibiotics. PET- CT
scanning revealed diffused aortitis. Both were treated with antibiotics
for more for than one year and their condition improved.
Conclusions: Infectious aortitis should always be considered in elderly
patients with atherosclerosis, a persistent and unexplained history
of fever, thoracic, abdominal, or back pain with or without positive
blood culture [1, 2].
References
1. Foote EA, Postier RG, Greenfield RA et al. Infectious aortitis. Curr
Treat Options Cardiovascular Med 2005;7:89–97.
2. Lopes RJ, Almeida J, Dias PJ et al. Infectious thoracic aortitis:
A literature review. Clin Cardiol 2009;32:488–490.
3. Mohan N, Kerr G. Aortitis. Curr Treat Options Cardiovascular Med
2002;4:247–254.
P-558
Herpes zoster and diabetes: more and more
C. Muñoz-Quiles, M. López-Lacort, J. Díez-Domingo. Vaccine Research,
Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la
Comunitat Valenciana, FISABIO-Public Health, Valencia, Spain
Introduction: The objective of this study was to asses the risk of
Herpes Zoster (HZ) in diabetics compared with non-diabetics and the
risk of negative impact of HZ on diabetes.
Methods: A retrospective cohort of all HZ patients aged over 49
years between 2009 and 2014 was selected using population and
health linked databases. HZ and diabetes were defined using ICD-9
codes. We compared incidence of HZ, and health care resource
consumption due to HZ in a 6 months period after HZ between
diabetic and non-diabetic population. We performed different
statistical generalized linear models to compare diabetic and non-
diabetic populations.
Results: The cohort consisted of 2,289,485 subjects ≥50 years old,
including 386,821 diabetics. HZ incidence rate was 935.52 cases/
100,000 diabetic population – year. The risk of HZ increased in
diabetics with respect to no-diabetics (RR 1.24, 95% credibility interval
[CrI] 1.22–1.26). Diabetics had 4% higher risk of attending to an
outpatient visit due to HZ than non-diabetic (RR 1.04, 95% confidence
interval [CI]: 1.02–1.05), they were more likely to be hospitalized
(OR 1.65, 95% CI: 1.40– 1.93), had higher risk of receiving medication
(RR 1.20, 95% CI: 1.16–1.24) and they had longer periods off work (Days
off work means ratio: 1.44, 95% CI: 1.09–1.92). 24% of well controlled
diabetics (A1C levels ≤6.5) worsen after HZ.
Conclusion: Diabetes increased by 24% the risk of HZ. HZ contributed
to a diabetes decompensation and higher health care resource
consumption than non-diabetics.
P-559
HIV in elder people – a forgotten disease
L. Pedro1, E. Campôa1, T.M. Gaspar1, F. Azevedo1, R. Pinho1, J. Gallardo1,
J.M. Ferreira2, D. Faria1, C. Santos1, L. Arez1. 1Algarve Hospital Center,
Portimão Hospital Unit, Department of Medicine 4, Portimão, 2Algarve
Hospital Center, Faro Hospital Unit, Department of Medicine 3, Faro,
Portugal
Introduction: Human immunodeficiency virus (HIV) is commonly
associated to younger individuals, being forgotten when the patient
has reached 65–80 years old or after the eighties (>80). Nevertheless,
as HIV associated death rate increases with age, is important to screen
and test people older than 65 years old.
Clinical case: An 89 year-old woman, autonomous, with a clinical
history of high blood pressure, medicated with 3 types of anti-
hypertensives was diagnosed HIV-1 due to possible post-transfusion
infection with a nadir CD4 of 647 cell/μL (stage 1). The patient was
medicated with 300 mg Abacavir, 150 mg Lamivudine and 300 mg
Zidovudine along with immunologic and virologic response. Admitted
in the ER for dyspnea and confusion; on clinical examination with
polypnea, decreased breath sounds and scattered hissing. After the
thorax x-ray a community-acquired bilateral pneumonia was propose
for diagnosis and antibacterial therapy with ceftriaxone was initiated.
However, although an analytical improvement and an apparent
response to the treatment, the patient developed a progressive
respiratory and haematological failure, ending with the death in the
24th day after hospital admittance.
Conclusion: In this case, although the sustained virologic suppression
and an apparent immune response, the inherent age immunologic
alterations with the HIV infection, even in a less severe stage, elevates
the tendency to infectionwith a high morbidity and mortality rate. It is
crucial, in HIV carrying patients, the medical team always consider the
associated and avoidable complications of the immunosuppressed
patient.
P-560
Clinical and economic burden of pneumococcal disease in older
adults with chronic conditions in the United States
H.K. Yang, D. Zhang, P. Mavros, T. Petigara. Merck & Co., Inc., Kenilworth,
New Jersey, USA
Background and aims: Older adults with chronic conditions are at
high risk for pneumococcal infection. Limited studies have examined
both the clinical and economic burden of pneumococcal disease in
this population. We assessed pneumococcal disease rates, resource
utilization and costs in US adults 65+ years with chronic conditions
indicated for pneumococcal vaccination by ACIP.
Methods: A retrospective cohort study using medical and pharmacy
claims fromHumana health plans was conducted to compare rates and
cost of all-cause pneumonia, pneumococcal pneumonia and invasive
pneumococcal disease (IPD) in immunocompetent older adults 65 + y
with and without chronic conditions. Conditions of interest were
diabetes, chronic heart, liver and lung disease, and asthma.
Results: Among 4.3 million older adults included in the analysis, 34.0%
had no condition; 31.3% had diabetes, 28.8% chronic heart disease,
17.5% chronic lung disease, 5.4% asthma and 2.9% chronic liver disease.
Older adults with chronic conditions had 3 times the rate of all-cause,
pneumococcal pneumonia, and IPD compared to healthy older adults.
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S176