Invasive pneumococcal disease in older adults residing in long-term care facilities and in the community

OBJECTIVES: To examine the epidemiology of invasive pneumococcal disease in older adults hospitalized for invasive pneumococcal disease who are living in the community and in long-term care facilities (LTCFs) in the United States. DESIGN: Analysis of 2,402 cases of invasive pneumococcal disease requiring hospitalization in 2000 and 2001 that the Centers for Disease Control and Prevention's Active Bacterial Core Surveillance collected in nine states. SETTING: Hospital. PARTICIPANTS: Hospitalized LTCF residents and community-living older adults in the United States. MEASUREMENTS: Age- and residence-specific pneumococcal disease incidence rates per 100,000 persons, case-fatality rates, and trends in antimicrobial resistance. RESULTS: Nationally, the rate of invasive pneumococcal disease in LTCF residents was 194.2 cases per 100,000 persons aged 65 and older and 44.6 for community-living older adults (relative risk=4.4, 95% confidence interval (CI)=4.2-4.5). Compared with community-living older adults, case-fatality rates were 1.9 times higher (30.8% vs 16.0%, 95% CI=1.5-2.5). Pneumococcal strains from LTCF residents were significantly more likely to be nonsusceptible to levofloxacin than strains from community- living older adults (5.7% vs 0.4%, P<.001). CONCLUSION: Older adults living in LTCFs are at a higher risk for invasive pneumococcal disease and death than are community-living older adults. Additionally, fluoroquinolone resistance is significantly higher in older adults living in LTCFs and may provide clues to emerging antimicrobial resistance in the general population.