The burden of respiratory infections among older adults in long-term care:a systematic review

BACKGROUND: Respiratory infections among older adults in long-term care facilities (LTCFs) are a major global concern, yet a rigorous systematic synthesis of the literature on the burden of respiratory infections in the LTCF setting is lacking. To address the critical need for evidence regarding the global burden of respiratory infections in LTCFs, we assessed the burden of respiratory infections in LTCFs through a systematic review of the published literature. METHODS: We identified articles published between April 1964 and March 2019 through searches of PubMed (MEDLINE), EMBASE, and the Cochrane Library. Experimental and observational studies published in English that included adults aged ≥60 residing in LTCFs who were unvaccinated (to identify the natural infection burden), and that reported measures of occurrence for influenza, respiratory syncytial virus (RSV), or pneumonia were included. Disagreements about article inclusion were discussed and articles were included based on consensus. Data on study design, population, and findings were extracted from each article. Findings were synthesized qualitatively. RESULTS: A total of 1451 articles were screened for eligibility, 345 were selected for full-text review, and 26 were included. Study population mean ages ranged from 70.8 to 90.1 years. Three (12%) studies reported influenza estimates, 7 (27%) RSV, and 16 (62%) pneumonia. Eighteen (69%) studies reported incidence estimates, 7 (27%) prevalence estimates, and 1 (4%) both. Seven (27%) studies reported outbreaks. Respiratory infection incidence estimates ranged from 1.1 to 85.2% and prevalence estimates ranging from 1.4 to 55.8%. Influenza incidences ranged from 5.9 to 85.2%. RSV incidence proportions ranged from 1.1 to 13.5%. Pneumonia prevalence proportions ranged from 1.4 to 55.8% while incidence proportions ranged from 4.8 to 41.2%. CONCLUSIONS: The reported incidence and prevalence estimates of respiratory infections among older LTCF residents varied widely between published studies. The wide range of estimates offers little useful guidance for decision-making to decrease respiratory infection burden. Large, well-designed epidemiologic studies are therefore still necessary to credibly quantify the burden of respiratory infections among older adults in LTCFs, which will ultimately help inform future surveillance and intervention efforts

The Ability of Virulence Factor Expression by <em>Pseudomonas aeruginosa</em> to Predict Clinical Disease in Hospitalized Patients

<div><h3>Background</h3><p><em>Pseudomonas aeruginosa</em> is an opportunistic pathogen that frequently causes hospital acquired colonization and infection. Accurate identification of host and bacterial factors associated with infection could aid treatment decisions for patients with <em>P. aeruginosa</em> cultured from clinical sites.</p> <h3>Methods</h3><p>We identified a prospective cohort of 248 hospitalized patients with positive <em>P. aeruginosa</em> cultures. Clinical data were analyzed to determine whether an individual met predefined criteria for infection versus colonization. <em>P. aeruginosa</em> isolates were tested for the expression of multiple phenotypes previously associated with virulence in animal models and humans. Logistic regression models were constructed to determine the degree of association between host and bacterial factors with <em>P. aeruginosa</em> infection of the bloodstream, lung, soft tissue and urinary tract.</p> <h3>Results</h3><p>One host factor (i.e. diabetes mellitus), and one bacterial factor, a Type 3 secretion system positive phenotype, were significantly associated with <em>P. aeruginosa</em> infection in our cohort. Subgroup analysis of patients with <em>P. aeruginosa</em> isolated from the urinary tract revealed that the presence of a urinary tract catheter or stent was an additional factor for <em>P. aeruginosa</em> infection.</p> <h3>Conclusions</h3><p>Among hospitalized patients with culture-documented <em>P. aeruginosa,</em> infection is more likely to be present in those with diabetes mellitus and those harboring a Type 3 secretion positive bacterial strain.</p> </div

Patient characteristics as a function of colonization vs. infection status.

<p>Patient characteristics as a function of colonization vs. infection status.</p

Clinical criteria for infection based on site of culture.

<p>Clinical criteria for infection based on site of culture.</p

Parsimonious multivariate analysis of factors associated with risk of <i>P. aeruginosa</i> infection.

<p>Parsimonious multivariate analysis of factors associated with risk of <i>P. aeruginosa</i> infection.</p

Sources of bacterial isolates as a function of clinical categorization.

*<p>Patients with <i>P. aeruginosa</i> isolated concurrently from blood and another site (n = 4) are analyzed with both blood and non-blood sites.</p