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performed, which revealed an urinary retention and an urethral

catheterization was attempted, creating a false passage with hema-

turia. The patient had a history of prostate adenoma with chronic

urinary retention, but nobody had the time to do a proper anamnesis.

The patient was redirected to the Urology Clinic, to solve the

catheterization, then to Pneumology and to Gastro-Enterology Clinic.

After 24 hours since arriving at the hospital, the patient had

extrasystolas, which required a Cardiological Consult. Each consult

was accompanied by a prescription, with a sum of 10 different drugs at

the end. The patient became dehydrated and extremely anxious,

which determined hospitalization in the Geriatric Clinic.


Practicing defensive medicine should be carefully

considered in senior patients, always under the supervision of the

general practitioner and/or geriatrician.


Antibiotic usage in community hospitals as a barometer of good

antibiotic stewardship

Y. Latief


, C. Lisk




Potters Bar Hospital,


Barnet Hospital, Royal Free NHS

Foundation Trust


Patients who are hospitalised have a high probability

of receiving an antibiotic. 50% of antibiotic use in hospital can be

inappropriate with risk of antibiotic resistance. Good antibiotic

stewardship is important to promote adherence to recommended

antibiotic treatment guidelines, review antibiotic consumption data

and control use of high risk antibiotics. We evaluated antibiotic usage

amongst inpatients in a 29 bed Rehabilitation unit in a UK community



Retrospective analysis of antibiotic usage was carried out

from 1st April 2015 to 30th April 2016. Demographics, comorbidities,

adherence to hospital antibiotic guidelines and usage of high risk

antibiotics were assessed.


100 patients received antibiotics. 58% (58) were aged 81


20% were above 91 and 63% (63) were female. The commonest

infections were urinary tract infections (UTI) 53% (53), Respiratory

infections (RIs) 23% (23) and Cellulitis (Cs) 21% (21). Antibiotics

commonly used in UTIs were Nitrofurantoin, Trimethoprim and

Gentamicin 79% (42/53); Cellulitis: Flucloxacillin 48% (10/21) and

Teicoplanin 33% (7/21); RIs: Amoxicillin 39% (9/23), Doxycycline 26%

(6/23). High risk antibiotics for Clostridium difficile infection were

used; Tazocin 4/53 UTIs, 7/23 RIs, 2/21 Cs. 2% (2) patients were treated

for Clostridium Difficile enteritis.


Antibiotic usage is common amongst older inpatients in

rehabilitation with good adherence to hospital antibiotic guidelines.

High risk antibiotics were used in line with antibiotic guidelines

for RIs, according to sensitivity patterns for UTIs and in discussion

with Microbiologists for Cs. Regular review of antibiotic usage is an

important aspect of antibiotic stewardship to ensure appropriate

antibiotic use.


Readmissions to acute hospitals from community hospitals; what

can we learn

R. McGeer


, C. Lisk




Barnet Hospital, United Kingdom


Emergency readmission rates within 30 days have been

increasing year on year costing the NHS 2.5 billion pounds yearly.

Research specifically pertaining to readmissions from community

hospitals to acute hospitals is scarce. We sought to develop an in-depth

understanding of the reasons for readmissions from a 29 bed com-

munity hospital in Hertsmere, United Kingdom back to acute



In depth analysis on all readmissions to acute hospitals

from the community hospital were collated from September 2013

to September 2014. Demographics, comorbidities, reasons for

transfer, days of the week transferred, length of stay and numbers of

transfers each month were collated and analysed via a Microsoft excel



68 transfers were identified. 36% of the patients (25) were

aged 90

100. 6 patients were responsible for 19% (13) of the transfers


3 each). The commonest reason for transfer was infection/sepsis

(31) patients, acute kidney injury (6) and gastrointestinal bleeding (5).

75% (51) of readmissions occurred within 30 days of admission to

the community hospital. The majority of transfers took place on a

Monday (14), Wednesday (14) and weekend (13).


Frail older adults are more likely to be readmitted for

medical reasons. 6 patients accounted for 20% of transfers suggesting

that Comprehensive Geriatric assessment in Acute Medical units are

likely to be beneficial. Infections accounted for almost half of the

readmissions suggesting that interventions need to be focused on

reducing the risk of hospital acquired infections.


Pulmonary cement pulmonary embolism after percuateneous

kyphoplasty: report of one case

J. Manzarbeitia, V. Martin, J. Costa, C. Ramon.

Servicio de Geriatria

Hospital Universitario de Gefate Universidad Europea de Madrid


Kyphoplasty is a recent procedure aplyed in Geraiatric

Medicine. One of the complications is Cement Embolism. The

incidence, diagnostic procedure and tratment of this complications

still remain unclear.


We expose here a case of pumonary cement embolism. A

kiphoplasty was performed in a 86 years-old woman. This treatment

soon resolve the pain, even she could leave opioids. However, she

refered malaise, exercise intolerance and dyspnea, so intense that she

could not walk more than 10 meters. She had Hypertension, and a

stage IIIb Cronic Renal Disease. She lived alone, without physical or

mental handicap. She went to Emergy Department where a diagnosis

of morfic withdrawl syndrome was made and discharged with

tapentalol at tappering doses. After 15 days she went to Geriatric

Deparment. At rest she was in no distress but when she walk she

felt bad an dyspneic suddenly, with tachycardia and tachypnea

with no others signs on phycal report. Electrochardiogram disclosed

sinus rythm without rigth ventricular overload. Creatinine was 3


miligrams/dL and D-Dimero was 10 times over normal range.


Thoracic computed tomography showed high intensity

radiolucent material deposition in pulmonary arteries and distal

segments. An echocardiogram indicated no Rigth Ventricular Overload

or significant Pulmonary Hypertension.

Key conclusions:

Cement pulmonary embolism should be considered

as a complication of Kyphoplasty. We should improve our knoledge of

this problem to avoid clinical and functional decline in othogeriatric



Iatrogenic mandibular osteonecrosis

J. Manzarbeitia, C. Ramon, V. Martin, C. Asenjo.

Servicio de Geriatria

Hospital universitario de Gefate. Universidad Europea de Madrid


Increasingly prescribed in geriatric population,

Bisphosphonates have been proven effective in treating osteoporosis.

ONJ is a rare but recognized complication, and may cause an important

deterioration of the quality of the patient life.


We report the case of a 82-years-old patient with a history of

complicated osteoporosis and moderate-severe degree of Alzheimer-

type dementia that begins with jaw discomfort in relation to taking

Ibandronate, suspended in 2012. The patient was diagnosed with ONJ

by Maxillofacial Surgery department. Since then the patient has

presented recurrent mandibular infections consistent of local pain,

psychomotor agitation, and denial for intake. Thus several cycles of

seven days Amoxicillin-clavulanate were administered. With anti-

biotic treatment, the patient improved early days but began to decline

again after three or four weeks of treatment completion and again

present psychomotor agitation and local inflammatory data. Surgical

treatment was dismissed as any invasive test considering the base

medical condition of the patient. In one of our visits they have been

Poster presentations / European Geriatric Medicine 7S1 (2016) S29