S54 Oral presentations / European Geriatric Medicine 5S1 (2014) S45–S81

the primary analysis. The RI of stroke was 1.69 (95%CI: 1.10–2.34)

following HZO and 1.41 (95%CI: 1.19–1.68) in the month after HZ

whatever the localization.

Conclusion: The study suggested a 40% and 30% increased risk of

stroke within 1 and 3 months after HZ infection, respectively. This

risk was higher after HZO.

O1.22

Infectious diseases

K.H. Hager, M.H.P. Parusel

Diakoniekrankenhaus Henriettenstiftung gGmbH, Hannover, Germany

Background: Colonization or infection with methicillin resistant

staphylococcus aureus (MRSA) are a problem in geriatric clinics,

especially when the majority of patients are referrals from other

clinics. MRSA colonization or infection may influence the functional

status and the treatment results of the patients.

Objective: The presence of a MRSA colonization or infection on

assessment results was evaluated.

Patients and Methods: From January 2008 to December 2009

patients admitted to the Center for Medicine in the Elderly in

Hannover a MRSA screening with a swab from mouth and nose

was done. As assessment tests the Mini Mental status examination

(MMSE) and the Geriatric Depression Scale (GDS) were done on

admission, the Functional Independence Measure (FIM) and the

Timed up and Go-Test (TuG) on admission and discharge.

Results: 131 had a MRSA detected either on admission or in the

course of the treatment. Patient data of 114 of these patients were

further analyzed and compared to 636 MRSA-free patients. On

admission a GDS with 0–5 points was found in 53.5% of the patients

with and in 56.1% in those without MRSA. A MMSE of 21–30

points was measured in 59.7% of the patients again with and in

67.6% of those without MRSA. The TuG on admission did not differ

between MRSA positive and negative patients. At discharge 16% of

the MRSA-negative patients had a TuG between 11–19 and 20–29

seconds, whereas 29% and 32% of the MRSA-negative patients were

found in this range. The FIM on admission was 64.8±23.7 points in

those with MRSA and 79.9±25.5 points in those without MRSA. At

discharge the FIM of the MRSA-patients was 75.6±30.4 points and

98.5±23.9 points in the patients without MRSA.

Conclusion: MRSA colonization or infection may have a major

impact on the treatment results in a geriatric clinic, especially on

the improvement in mobility and in the activities of daily living.

O1.23

The effect of tailored antibiotic stewardship programmes on

appropriateness of antibiotic prescribing in nursing homes

L.W. van Buul1, J.T. van der Steen1, W.P. Achterberg2,

F.G. Schellevis3, R.T.G.M. Essink4, S.C. de Greeff5, S. Natsch6,

P.D. Sloane7, S. Zimmerman7, J.W.R. Twisk1, R.B. Veenhuizen1,

C.M.P.M. Hertogh1

1VU University Medical Center, Amsterdam, The Netherlands;2Leiden University Medical Center, Leiden, The Netherlands; 3NIVEL

(Netherlands Institute for Health Services Research), Utrecht,

The Netherlands; 4Dutch Institute for Rational Use of Medicine (IVM),

Utrecht, The Netherlands; 5National Institute for Public Health and

the Environment (RIVM), Bilthoven, The Netherlands; 6Radboud

University Medical Centre, Nijmegen, The Netherlands; 7University of

North Carolina at Chapel Hill, Chapel Hill, USA

Introduction: The increase of antimicrobial-resistant pathogens

in nursing homes (NHs) highlights the importance of promoting

appropriate antibiotic use in this setting. We evaluated the

appropriateness of antibiotic prescribing following tailored

interventions developed and implemented in a participatory action

research (PAR) project.

Methods: A pre-post test controlled design involved 5

intervention and 5 control NHs. Baseline data regarding

prescribing were provided to intervention NHs. Subsequently,

in multidisciplinary meetings, tailored interventions to improve

prescribing appropriateness were developed and implemented

(e.g., education, medication review). A guideline-based treatment

algorithm was used to evaluate treatment decisions. Data were

analyzed with descriptive statistics and a mixed logistic regression

model.

Results: Appropriateness of 1,059 treatment decisions was

assessed. At pre-test, 76% of the treatment decisions were

appropriate. Adjusted for pre-test differences in appropriate

prescribing, post-test appropriateness of antibiotic prescribing did

not differ between intervention and control NHs (crude: p = 0.26;

adjusted for covariates: p = 0.35). Subanalyses also indicated no

significant effects per infection type. A trend was observed towards

more appropriate prescribing at the initiation of data collection,

and shortly before receiving feedback on prescribing behavior.

Conclusions: The tailored interventions implemented in our PAR

project did not result in more appropriate prescribing. Possible

explanations include the relatively high baseline performance in the

participating NHs, and selection of less effective interventions by

local stakeholders. Given previous reporting of reduced prescribing

following the act of monitoring – which is consistent with our

observed trend – there may be cause to promote the simple

intervention of ongoing monitoring of antibiotic prescribing.

Delirium

O2.01

Delirium risk stratification in consecutive unselected acute

medical admissions

S.T. Pendlebury1, N.G. Lovett2, S.C. Smith3, E. Cornish3, Z. Mehta2,

P.M. Rothwell2

1Oxford NIHR Biomedical Reseach Centre, Oxford, United Kingdom;2Stroke Prevention Research Unit, Nuffield Department of Clinical

Neurosciences, Oxford, United Kingdom; 3John Radcliffe Hospital,

Oxford, United Kingdom

Introduction: Reliable risk stratification will aid delirium

recognition, anticipation and prevention. We therefore determined

rates and risk factors for delirium in consecutive unselected acute

medical admissions and the reliability of independently derived

risk scores.

Methods: Consecutive admissions over 16 weeks (2010, 2012)

were screened on arrival and daily thereafter using the Confusion

Assessment Method (CAM) and DSM IV criteria. The reliability

of established delirium risk scores and a score derived from

factors reported in NICE guidelines (age >80 years = 2, cognitive

impairment (AMTS <9 or MMSE <24) = 2, poor vision/hearing = 1,

severe illness = 1, infection = 1) was examined using the area under

the receiver operating curve (AUC).

Results: In 503 patients (age median = 72.0, range 16–99 years,

236 (48%) male), delirium occurred in 101/503 (20%) patients

overall with a strong age-dependent relationship: 6/203 (3%) for

<65 years versus 10/68 (16%) for 65–74 years and 85/232 (36%) for

≥75 years (p < 0.0001). Of the five delirium risk scores assessed,

the NICE score tended to perform best overall (AUC 0.77, 0.70–

0.84), risk ranging from 12% in the lowest tertile of risk to 70%

in the highest. The presence of two or more non-age NICE factors

approximately trebled the risk of delirium irrespective of age but

older age conferred greater overall susceptibility.

Conclusions: Delirium affected over a third of those aged ≥75 years

in acute medicine, justifying routine delirium screening in this

group. Risk scores appear to have clinical utility in identifying high

risk patients and thus optimal delirium management and may aid

patient selection for future clinical trials.