Hospitalization after Oral Antibiotic Initiation in Finnish Community Dwellers with and without Alzheimer’s Disease: Retrospective Register-Based Cohort Study
Restricted accessResearch articleFirst published online June 19, 2018
Hospitalization after Oral Antibiotic Initiation in Finnish Community Dwellers with and without Alzheimer’s Disease: Retrospective Register-Based Cohort Study
Persons with Alzheimer’s disease (AD) are frequently hospitalized from infection-related causes. There are no previous studies investigating hospitalization associated with antibiotic initiation in persons with AD.
Objective:
To investigate the frequency and risk of hospitalization associated with oral antibiotic initiation among community dwellers with and without AD.
Methods:
We performed a retrospective register-based study utilizing register-based Medication Use and Alzheimer’s disease (MEDALZ) cohort. It includes all community dwellers diagnosed with AD during 2005–2011 in Finland and their matched comparison persons without AD. Antibiotic use was initiated by 34,785 persons with and 36,428 without AD. Drug use data were collected from Prescription Register and comorbidities from Special Reimbursement and Hospital Care Registers. Infection diagnoses were collected from the Hospital Care Register. Factors associated with hospitalization were estimated utilizing logistic regression models.
Results:
Risk of hospitalization following antibiotic initiation was higher among antibiotic initiators with AD than without AD (adjusted odds ratio, aOR, 1.37, 95% Cl 1.28–1.46).
Strongest association with hospitalization was found for oral glucocorticoid use, aOR 1.41 (1.25–1.59); epilepsy, aOR 1.33 (1.10–1.63); and active cancer, aOR 1.30 (1.14–1.49). Among initiators of cephalexin, pivmecillinam, amoxicillin/amoxicillin, and enzyme inhibitor and doxycycline, persons with AD were more frequently hospitalized than persons without AD. A quarter of hospitalized antibiotic initiators had infection diagnosis in their hospital care records.
Conclusions:
Persons with AD initiating an antibiotic had a higher risk for hospitalization than antibiotic initiators without AD. Further research is needed to determine whether infection-related hospitalization could be reduced.
AlbertSM, CostaR, MerchantC, SmallS, JendersRA, SternY (1999) Hospitalization and Alzheimer’s disease: Results from a community-based study. J Gerontol A Biol Sci Med Sci54, 267.
2.
TolppanenAM, TaipaleH, PurmonenT, KoponenM, SoininenH, HartikainenS (2015) Hospital admissions, outpatient visits and healthcare costs of community-dwellers with Alzheimer’s disease. Alzheimers Dement11, 955-963.
3.
ZhaoY, KuoTC, WeirS, KramerMS, AshAS (2008) Healthcare costs and utilization for Medicare beneficiaries with Alzheimer’s. BMC Health Serv Res8, 108.
4.
NatalwalaA, PotluriR, UppalH, HeunR (2008) Reasons for hospital admissions in dementia patients in Birmingham, UK, during2002-2007. Dement Geriatr Cogn Disord26, 499-505.
5.
MaloneDC, McLaughlinTP, WahlPM, LeibmanC, ArrighiHM, CzirakyMJ, MuchaLM (2009) Burden of Alzheimer’s disease and association with negative health outcomes. Am J Manag Care15, 481-488.
6.
PhelanEA, BorsonS, GrothausL, BalchS, LarsonEB (2012) Association of incident dementia with hospitalizations. JAMA307, 165-172.
7.
GuijarroR, RomanCMS, Gomez-HuelgasR, VillalobosA, MartinM, GuilM, Martinez-GonzalezMA, ToledoJB (2010) Impact of dementia on hospitalization. Neuroepidemiology35, 101-108.
8.
SampsonEL, BlanchardMR, JonesL, TookmanA, KingM (2009) Dementia in the acute hospital: Prospective cohort study of prevalence and mortality. Br J Psychiatry195, 61-66.
9.
PedoneC, ErcolaniS, CataniM, MaggioD, RuggieroC, QuartesanR, SeninU, MecocciP, CherubiniA, GroupGS (2005) Elderly patients with cognitive impairment have a high risk for functional decline during hospitalization: The GIFA Study. J Gerontol A Biol Sci Med Sci60, 1576-1580.
10.
WilsonRS, HebertLE, ScherrPA, DongX, LeurgensSE, EvansDA (2012) Cognitive decline after hospitalization in a community population of older persons. Neurology78, 950-956.
11.
GeorgeJ, BleasdaleS, SingletonSJ (1997) Causes and prognosis of delirium in elderly patients admitted to a district general hospital. Age Ageing26, 423-427.
12.
AhmedS, LeurentB, SampsonEL (2014) Risk factors for incident delirium among older people in acute hospital medical units: A systematic review and meta-analysis. Age Ageing43, 326-333.
13.
FickDM, AgostiniJV, InouyeSK (2002) Delirium superimposed on dementia: A systematic review. J Am Geriatr Soc50, 1723-1732.
14.
FongTG, JonesRN, MarcantonioER, TommetD, GrossAL, HabtemariamD, SchmittE, YapL, InouyeSK (2012) Adverse outcomes after hospitalization and delirium in persons with Alzheimer disease. Ann Intern Med156, 848-856, W296.
15.
RautakorpiUM, HuikkoS, HonkanenP, KlaukkaT, MakelaM, PalvaE, RoineR, SarkkinenH, VaronenH, HuovinenP, MIKSTRA Collaborative Study Group (2006) The Antimicrobial Treatment Strategies (MIKSTRA) program: A 5-year follow-up of infection-specific antibiotic use in primary health care and the effect of implementation of treatment guidelines. Clin Infect Dis42, 1221-1230.
16.
CurnsAT, HolmanRC, SejvarJJ, OwingsMF, SchonbergerLB (2005) Infectious disease hospitalizations among older adults in the United States from 1990 through 2002. Arch Intern Med165, 2514-2520.
17.
RubenFL, DearwaterSR, NordenCW, KullerLH, GartnerK, ShalleyA, WarshafskyG, KelseySF, O’DonnellC, MeansE (1995) Clinical infections in the noninstitutionalized geriatric age group: Methods utilized and incidence of infections. The Pittsburgh Good Health Study. Am J Epidemiol141, 145-157.
McKhannG, DrachmanD, FolsteinM, KatzmanR, PriceD, StadlanEM (1984) Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology34, 939-944.
20.
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, American Psychiatric Association, Washington, DC.
21.
Finnish Medical Society Duodecim (2017) Current care: Memory Disorders.
22.
(2017) WHO Collaborating Centre for Drug Statistics Methodology: The Anatomical Therapeutic Chemical (ATC) classification system. Oslo, Norway.
23.
TanskanenA, TaipaleH, KoponenM, TolppanenAM, HartikainenS, AhonenR, TiihonenJ (2015) From prescription drug purchases to drug use periods - a second generation method (PRE2DUP). BMC Med Inform Decis Mak15, 21.
24.
TaipaleH, TanskanenA, KoponenM, TolppanenAM, TiihonenJ, HartikainenS (2016) Agreement between PRE2DUP register data modeling method and comprehensive drug use interview among older persons. Clin Epidemiol8, 363-371.
25.
HaminaA, TaipaleH, TanskanenA, TolppanenAM, TiihonenJ, HartikainenS (2017) Differences in analgesic use in community-dwelling persons with and without Alzheimer’s disease. Eur J Pain21, 658-667.
26.
SaarelainenL, TolppanenAM, KoponenM, TanskanenA, SundR, TiihonenJ, HartikainenS, TaipaleH (2017) Risk of hip fracture in benzodiazepine users with and without Alzheimer disease.. J Am Med Dir Assoc18, 87.e21.
27.
HaminaA, TaipaleH, TanskanenA, TolppanenAM, KarttunenN, PylkkanenL, TiihonenJ, HartikainenS (2017) Long-term use of opioids for nonmalignant pain among community-dwelling persons with and without Alzheimer disease in Finland: A nationwide register-based study. Pain158, 252-260.
28.
AlonD, SteinGY, KorenfeldR, FuchsS (2013) Predictors and outcomes of infection-related hospital admissions of heart failure patients. PLoS One8, e72476.
29.
HamiltonEJ, MartinN, MakepeaceA, SillarsBA, DavisWA, DavisTM (2013) Incidence and predictors of hospitalization for bacterial infection in community-based patients with type 2 diabetes: The fremantle diabetes study.PLoS One8, e60502.
30.
TeichtahlH, BuckmasterN, PertnikovsE (1997) The incidence of respiratory tract infection in adults requiring hospitalization for asthma. Chest112, 591-596.
31.
HolttaEH, LaurilaJV, LaakkonenML, StrandbergTE, TilvisRS, PitkalaKH (2014) Precipitating factors of delirium: Stress response to multiple triggers among patients with and without dementia. Exp Gerontol59, 42-46.
Lavizzo-MoureyRJ (1987) Dehydration in the elderly: A short review. J Natl Med Assoc79, 1033-1038.
34.
TinettiME, SpeechleyM, GinterSF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med319, 1701-1707.
35.
van DijkPT, MeulenbergOG, van deSande HJ, HabbemaJD (1993) Falls in dementia patients. Gerontologist33, 200-204.
36.
TaipaleH, TolppanenA-M, KoponenM, TanskanenA, LavikainenP, SundR, TiihonenJ, HartikainenS (2017) Risk of pneumonia associated with incident benzodiazepine use among community-dwelling adults with Alzheimer disease.. CMAJ189, E519-E529.
37.
TolppanenA-M, KoponenM, TanskanenA, LavikainenP, SundR, TiihonenJ, HartikainenS, TaipaleH (2016) Antipsychotic use and risk of hospitalization or death due to pneumonia in persons with and those without Alzheimer disease. Chest150, 1233-1241.
38.
LampelaP, TolppanenA-M, TanskanenA, TiihonenJ, LavikainenP, HartikainenS, TaipaleH (2017) Use of antidementia drugs and risk of pneumonia in older persons with Alzheimer’s disease. Ann Med49, 230-239.
39.
LeipzigRM, CummingRG, TinettiME (1999) Drugs and falls in older people: A systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc47, 30-39.
40.
PerttilaNM, OhmanH, StrandbergTE, KautiainenH, RaivioM, LaakkonenML, SavikkoN, TilvisRS, PitkalaKH (2017) How do community-dwelling persons with Alzheimer disease fall? Falls in the FINALEX Study. Dement Geriatr Cogn Dis Extra7, 195-203.
41.
LaurilaJV, LaakkonenML, TilvisRS, PitkalaKH (2008) Predisposing and precipitating factors for delirium in a frail geriatric population. J Psychosom Res65, 249-254.
42.
Finnish Medicines Agency Summary of Product Characteristics (SPC). 2017.
43.
SolomonA, NganduT, SoininenH, HallikainenMM, KivipeltoM, LaatikainenT (2014) Validity of dementia and Alzheimer’s disease diagnoses in Finnish national registers. Alzheimers Dement10, 303-309.
44.
WettermarkB, ZoegaH, FuruK, KorhonenM, HallasJ, NorgaardM, AlmarsdottirA, AndersenM, SundellKA, BergmanU, Helin-SalmivaaraA, HoffmannM, KielerH, MartikainenJ, MortensenM, PetzoldM, Wallach-KildemoesH, WallinC, SorensenH (2013) The Nordic prescription databases as a resource for pharmacoepidemiological research–a literature review. Pharmacoepidemiol Drug Saf22, 691-699.
