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Annals of Family Medicine 3:422-429 (2005)
© 2005 Annals of Family Medicine, Inc.
doi: 10.1370/afm.389
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Antibiotic Treatment and Survival of Nursing Home Patients With Lower Respiratory Tract Infection: A Cross-National Analysis

Robin L. Kruse, PhD1, David R. Mehr, MD, MS1, Jenny T. van der Steen, PhD2,3,4, Marcel E. Ooms, MD, PhD2,3, Richard W. Madsen, PhD5, Ashley K. Sherman, MA5, Ralph B. D’Agostino, PhD6, Gerrit van der Wal, MD, PhD3,4 and Miel W. Ribbe, MD, PhD2,3

1 Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, Mo
2 Department of Nursing Home Medicine of the VU University Medical Center, Amsterdam, The Netherlands
3 Institute for Research in Extramural Medicine (EMGO Institute) of the VU University Medical Center, Amsterdam, The Netherlands
4 Department of Public and Occupational Health of the VU University Medical Center, Amsterdam, The Netherlands
5 Biostatistics Unit, Office of Medical Research, University of Missouri-Columbia, Columbia, Mo
6 Mathematics and Statistics Department, Boston University, Boston, Mass

CORRESPONDING AUTHOR: Robin L. Kruse, PhD, Department of Family and Community Medicine, University of Missouri-Columbia School of Medicine, Columbia, MO 65212, kruser{at}health.missouri.edu

PURPOSE Although lower respiratory tract infections are a leading cause of death in frail elderly patients, few studies have compared treatments and outcomes. We assessed the effects of different antibiotic treatment strategies on survival of elderly nursing home residents with lower respiratory tract infections in the United States and the Netherlands, where treatment approaches are quite different.

METHODS We combined data from 2 prospective cohort studies of lower respiratory tract infections conducted in 36 nursing homes in the United States and 61 in the Netherlands. We included residents whose infections were treated with antibiotics: 806 in the United States and 415 in the Netherlands. Outcome measures were 1-month and 3-month mortality. We used logistic regression to adjust for differing illness severity.

RESULTS Dutch residents had higher mortality than US residents (28.1% vs 15.1% at 1 month, respectively; P <.001). After adjusting for illness severity with logistic regression, the differences between the Dutch and US populations were not significant (odds ratio 1.34; 95% confidence interval, 0.94–1.90). Predicted mortality was overestimated for more severely ill US residents at 1 month but not at 3 months. No antibiotic regimen was consistently associated with increased or decreased mortality.

CONCLUSION Despite differences in illness severity and treatment, adjusted mortality did not differ between the 2 countries. Although we cannot exclude a short-term survival benefit from more aggressive treatment in the United States, differences in baseline health appear prognostically more important than the type of antibiotic treatment.

Key Words: Nursing homes • aged • respiratory tract infections • pneumonia • anti-bacterial agents • delivery of health care • health services research




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