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Herausforderungen durch Infektionen und mehrfach-resistente Bakterien bei alten Menschen in Heimen

The challenge of infections and multiresistant bacteria among the elderly living in long-term care facilities

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Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Nosokomiale Infektionen betreffen nicht nur Patienten, die im Rahmen von Krankenhausaufenthalten behandelt werden, sondern auch Menschen, die im Bereich der stationären und ambulanten Pflege versorgt werden. Da dies in der Regel ältere Menschen sind, birgt der demografische Wandel in Deutschland eine Vielzahl neuer Herausforderungen im Bereich der Infektionsprävention. Der Alterungsprozess des Menschen geht mit einigen physiologischen Veränderungen einher, die die individuelle Disposition gegenüber Infektionskrankheiten erhöhen können. Für alte Menschen, die in Heimen leben, ergeben sich durch den Gemeinschaftsalltag, durch pflegerische Maßnahmen und den teils inadäquaten Einsatz von Antibiotika mitunter zusätzliche Infektionsrisiken. Bakterien, die Resistenzen gegenüber gebräuchlichen antimikrobiellen Wirkstoffen erworben haben, sind auch bei Bewohnern von Pflegeeinrichtungen inzwischen verbreitet. Die Einrichtungen müssen sich im Rahmen ihrer Präventionskonzepte der Aufgabe stellen, eine geeignete Balance zwischen der Wahrung des häuslichen Lebensumfelds und dem Infektionsschutz zu finden, und fühlen sich hierbei vielfach allein gelassen. Der vorliegende Beitrag soll einen Einblick geben in die Charakteristika der Infektionen des alten Menschen, insbesondere im Hinblick auf die stationäre Pflege.

Abstract

Healthcare-associated infections not only affect patients in acute care hospitals but also patients in need of long-term care. As the elderly are generally most affected, the demographic change in Germany faces a range of increasing challenges in the field of infection control. The ageing process itself is accompanied by several physiological and pathological changes which may result in an increase in the risk of infectious diseases. Elderly living in long-term care facilities (LTCFs) may in addition be exposed to further risks due to their everyday life in a community, nursing care and the, to some extent, inappropriate use of antibiotics. Bacteria that have become resistant to commonly used antimicrobial agents are meanwhile prevalent in nursing homes. Caregivers often feel left alone when facing the task of achieving a balance between the need for a comfortable familiar environment and the application of infection control measures according to a resolute prevention strategy. This review aims to give an overview about the characteristics of infections among the elderly, especially with respect to long-term care.

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Literatur

  1. Statistisches Bundesamt (2010) Demografischer Wandel, Auswirkungen auf Krankenhausbehandlungen und Pflegebedürftige im Bund und in den Ländern. Statistisches Bundesamt, Wiesbaden

  2. Statistisches Bundesamt, Pfaff H (2011) Pflegestatistik 2009 Pflege im Rahmen der Pflegeversicherung Deutschlandergebnisse. In: Pflegestatistik. Statistisches Bundesamt, Wiesbaden

  3. Ramroth H, Specht-Leible N, König H-H et al (2006) Use of hospital based resources by individuals in residential care homes. Dtsch Arztebl Int 103:2710–2713

    Google Scholar 

  4. Specht-Leible N, Bender M, Oster P (2003) Causes for in-hospital treatment of nursing home residents. Z Gerontol Geriatr 36:274–279

    Article  PubMed  CAS  Google Scholar 

  5. Castle SC (2000) Clinical relevance of age-related immune dysfunction. Clin Infect Dis 31:578–585

    Article  PubMed  CAS  Google Scholar 

  6. Ben-Yehuda A, Weksler ME (1992) Host resistance and the immune system. Clin Geriatr Med 8:701–711

    PubMed  CAS  Google Scholar 

  7. Yoshikawa TT (2000) Epidemiology and unique aspects of aging and infectious diseases. Clin Infect Dis 30:931–933

    Article  PubMed  CAS  Google Scholar 

  8. Meyer KC (2001) The role of immunity in susceptibility to respiratory infection in the aging lung. Respir Physiol 128:23–31

    Article  PubMed  CAS  Google Scholar 

  9. Nicolle LE (2000) Urinary tract infection in long-term-care facility residents. Clin Infect Dis 31:757–761

    Article  PubMed  CAS  Google Scholar 

  10. Levkoff SE, Marcantonio ER (1994) Delirium: a major diagnostic and therapeutic challenge for clinicians caring for the elderly. Compr Ther 20:550–557

    PubMed  CAS  Google Scholar 

  11. Yoshikawa TT (1997) Perspective: aging and infectious diseases: past, present, and future. J Infect Dis 176:1053–1057

    Article  PubMed  CAS  Google Scholar 

  12. Yoshikawa TT, Norman DC (1996) Approach to fever and infection in the nursing home. J Am Geriatr Soc 44:74–82

    PubMed  CAS  Google Scholar 

  13. Nicolle LE (2002) Urinary tract infection in geriatric and institutionalized patients. Curr Opin Urol 12:51–55

    Article  PubMed  Google Scholar 

  14. Marrie TJ (2000) Community-acquired pneumonia in the elderly. Clin Infect Dis 31:1066–1078

    Article  PubMed  CAS  Google Scholar 

  15. Wischnewski N, Mielke M, Wendt C (2011) Healthcare-associated infections in long-term care facilities. German results of the European prevalence study HALT. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 54:1147–1152

    Article  CAS  Google Scholar 

  16. Bradley SF (1999) Issues in the management of resistant bacteria in long-term-care facilities. Infect Control Hosp Epidemiol 20:362–366

    Article  PubMed  CAS  Google Scholar 

  17. Engelhart ST, Hanses-Derendorf L, Exner M, Kramer MH (2005) Prospective surveillance for healthcare-associated infections in German nursing home residents. J Hosp Infect 60:46–50

    Article  PubMed  CAS  Google Scholar 

  18. Strausbaugh LJ, Sukumar SR, Joseph CL (2003) Infectious disease outbreaks in nursing homes: an unappreciated hazard for frail elderly persons. Clin Infect Dis 36:870–876

    Article  PubMed  Google Scholar 

  19. Smith PW, Seip CW, Schaefer SC, Bell-Dixon C (2000) Microbiologic survey of long-term care facilities. Am J Infect Control 28:8–13

    Article  PubMed  CAS  Google Scholar 

  20. Nicolle LE (2002) Resistant pathogens in urinary tract infections. J Am Geriatr Soc 50:230–235

    Article  Google Scholar 

  21. Kanellakopoulou K, Grammelis V, Baziaka F et al (2009) Bacterial flora in residents of long-term care facilities: a point prevalence study. J Hosp Infect 71:385–387

    Article  PubMed  CAS  Google Scholar 

  22. Mody L, Kauffman CA, Donabedian S et al (2008) Epidemiology of Staphylococcus aureus colonization in nursing home residents. Clin Infect Dis 46:1368–1373

    Article  PubMed  Google Scholar 

  23. Dommeti P, Wang L, Flannery EL et al (2011) Patterns of ciprofloxacin-resistant gram-negative bacteria colonization in nursing home residents. Infect Control Hosp Epidemiol 32:177–180

    Article  PubMed  Google Scholar 

  24. Gurwitz JH, Field TS, Avorn J et al (2000) Incidence and preventability of adverse drug events in nursing homes. Am J Med 109:87–94

    Article  PubMed  CAS  Google Scholar 

  25. Bernabei R, Gambassi G, Lapane K et al (1999) Characteristics of the SAGE database: a new resource for research on outcomes in long-term care. SAGE (Systematic Assessment of Geriatric drug use via Epidemiology) Study Group. J Gerontol A Biol Sci Med Sci 54:M25–33

    Article  PubMed  CAS  Google Scholar 

  26. Nicolle LE, Strausbaugh LJ, Garibaldi RA (1996) Infections and antibiotic resistance in nursing homes. Clin Microbiol Rev 9:1–17

    PubMed  CAS  Google Scholar 

  27. Gavazzi G, Krause KH (2002) Ageing and infection. Lancet Infect Dis 2:659–666

    Article  PubMed  Google Scholar 

  28. Irvine PW, Van Buren N, Crossley K (1984) Causes for hospitalization of nursing home residents: the role of infection. J Am Geriatr Soc 32:103–107

    PubMed  CAS  Google Scholar 

  29. Strausbaugh LJ, Joseph CL (2000) The burden of infection in long-term care. Infect Control Hosp Epidemiol 21:674–679

    Article  PubMed  CAS  Google Scholar 

  30. McGeer A, Campbell B, Emori TG et al (1991) Definitions of infection for surveillance in long-term care facilities. Am J Infect Control 19:1–7

    Article  PubMed  CAS  Google Scholar 

  31. Engelhart S, Lauer A, Simon A et al (2009) Repeated prevalence investigations of nursing home-associated infections as a tool to assess the hygienic quality of care. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 52:936–944

    Article  CAS  Google Scholar 

  32. Schulz M, Mielke M, Wischnewski N (2011) Clusters of infectious diseases in German nursing homes: observations from a prospective infection surveillance study, October 2008 to August 2009. Euro Surveill 16

  33. Eriksen HM, Iversen BG, Aavitsland P (2004) Prevalence of nosocomial infections and use of antibiotics in long-term care facilities in Norway, 2002 and 2003. J Hosp Infect 57:316–320

    Article  PubMed  CAS  Google Scholar 

  34. Moro ML, Mongardi M, Marchi M, Taroni F (2007) Prevalence of long-term care acquired infections in nursing and residential homes in the Emilia-Romagna Region. Infection 35:250–255

    Article  PubMed  CAS  Google Scholar 

  35. Chami K, Gavazzi G, Carrat F et al (2011) Burden of infections among 44,869 elderly in nursing homes: a cross-sectional cluster nationwide survey. J Hosp Infect 79:254–259

    Article  PubMed  CAS  Google Scholar 

  36. Utsumi M, Makimoto K, Quroshi N, Ashida N (2010) Types of infectious outbreaks and their impact in elderly care facilities: a review of the literature. Age Ageing 39:299–305

    Article  PubMed  Google Scholar 

  37. Baum H von, Schmidt C, Svoboda D et al (2002) Risk factors for methicillin-resistant Staphylococcus aureus carriage in residents of German nursing homes. Infect Control Hosp Epidemiol 23:511–515

    Article  Google Scholar 

  38. Woltering R, Hoffmann G, Daniels-Haardt I et al (2008) Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in patients in long-term care in hospitals, rehabilitation centers and nursing homes of a rural district in Germany. Dtsch Med Wochenschr 133:999–1003

    Article  PubMed  CAS  Google Scholar 

  39. Bock-Hensley O, Wendt C (2009) Methicillin-resistant Staphylococcus aureus in nursing homes. MMW Fortschr Med 151:41–45; quiz 46

    PubMed  CAS  Google Scholar 

  40. Neuhaus B, Bocter N, Braulke C et al (2002) Studie zum Vorkommen von Methicillin-resistenten Staphylococcus aureus in Alten- und Altenpflegeheimen in Nordrhein-Westfalen. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 45:894–904

    Article  Google Scholar 

  41. Pfingsten-Wurzburg S, Pieper DH, Bautsch W, Probst-Kepper M (2011) Prevalence and molecular epidemiology of meticillin-resistant Staphylococcus aureus in nursing home residents in northern Germany. J Hosp Infect 78:108–112

    Article  PubMed  CAS  Google Scholar 

  42. Reynolds C, Quan V, Kim D et al (2011) Methicillin-resistant Staphylococcus aureus (MRSA) carriage in 10 nursing homes in Orange County, California. Infect Control Hosp Epidemiol 32:91–93

    Article  PubMed  Google Scholar 

  43. Greenland K, Rijnders MI, Mulders M et al (2011) Low prevalence of methicillin-resistant Staphylococcus aureus in Dutch nursing homes. J Am Geriatr Soc 59:768–769

    Article  PubMed  Google Scholar 

  44. Wendt C, Krause C, Xander LU et al (1999) Prevalence of colonization with vancomycin-resistant enterococci in various population groups in Berlin, Germany. J Hosp Infect 42:193–200

    Article  PubMed  CAS  Google Scholar 

  45. March A, Aschbacher R, Dhanji H et al (2009) Colonization of residents and staff of a long-term-care facility and adjacent acute-care hospital geriatric unit by multiresistant bacteria. Clin Microbiol Infect

  46. Benenson S, Cohen MJ, Block C et al (2009) Vancomycin-resistant enterococci in long-term care facilities. Infect Control Hosp Epidemiol 30:786–789

    Article  PubMed  Google Scholar 

  47. Rooney PJ, O’Leary MC, Loughrey AC et al (2009) Nursing homes as a reservoir of extended-spectrum beta-lactamase (ESBL)-producing ciprofloxacin-resistant Escherichia coli. J Antimicrob Chemother 64:635–641

    Article  PubMed  CAS  Google Scholar 

  48. Pop-Vicas A, Mitchell SL, Kandel R et al (2008) Multidrug-resistant gram-negative bacteria in a long-term care facility: prevalence and risk factors. J Am Geriatr Soc 56:1276–1280

    Article  PubMed  Google Scholar 

  49. Colodner R, Kometiani I, Chazan B, Raz R (2008) Risk factors for community-acquired urinary tract infection due to quinolone-resistant E. coli. Infection 36:41–45

    Article  PubMed  CAS  Google Scholar 

  50. Ben-Ami R, Schwaber MJ, Navon-Venezia S et al (2006) Influx of extended-spectrum beta-lactamase-producing enterobacteriaceae into the hospital. Clin Infect Dis 42:925–934

    Article  PubMed  CAS  Google Scholar 

  51. Safdar N, Maki DG (2002) The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, enterococcus, gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med 136:834–844

    PubMed  Google Scholar 

  52. Bradley SF (1997) Methicillin-resistant Staphylococcus aureus in nursing homes. Epidemiology, prevention and management. Drugs Aging 10:185–198

    Article  PubMed  CAS  Google Scholar 

  53. GERMAP (2010) Antibiotika-Resistenz und -Verbrauch. In: Bundesamt für Verbraucherschutz und Lebensmittelsicherheit; Paul-Ehrlich-Gesellschaft für Chemotherapie e.V.; Infektiologie Freiburg

  54. O’Fallon E, Pop-Vicas A, D’Agata E (2009) The emerging threat of multidrug-resistant gram-negative organisms in long-term care facilities. J Gerontol A Biol Sci Med Sci 64:138–141

    Google Scholar 

  55. Latour K, Catry B, Broex E et al (2012) Indications for antimicrobial prescribing in European nursing homes: results from a point prevalence survey. Pharmacoepidemiol Drug Saf

  56. McCusker J, Cole M, Dendukuri N et al (2001) Delirium in older medical inpatients and subsequent cognitive and functional status: a prospective study. CMAJ 165:575–583

    PubMed  CAS  Google Scholar 

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Danksagung

Besonderer Dank gilt Herrn Dr. Alfred Nassauer für die kritische und konstruktive Korrektur des Manuskripts.

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

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  1. Abteilung für Infektionskrankheiten, Fachgebiet 14 (Angewandte Infektions- und Krankenhaushygiene), Robert Koch-Institut, Nordufer 20, 13353, Berlin, Deutschland

    C. Ruscher & M. Mielke

  2. Institut für Medizinische Mikrobiologie und Infektionsepidemiologie, Universität Leipzig, Leipzig, Deutschland

    R. Schaumann

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Correspondence to C. Ruscher.

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Ruscher, C., Schaumann, R. & Mielke, M. Herausforderungen durch Infektionen und mehrfach-resistente Bakterien bei alten Menschen in Heimen. Bundesgesundheitsbl. 55, 1444–1452 (2012). https://doi.org/10.1007/s00103-012-1555-7

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