ABSTRACT
Vancomycin-resistant enterococci (VRE) commonly colonize, but less frequently infect, debilitated patients, such as those on chronic renal dialysis. The emergence of VRE amongst our cohort of renal replacement therapy patients posed considerable challenges in our attempts to prevent spread. Although 60 of 451 (13%) patients became colonized, only two patients required systemic antibiotics for confirmed or suspected invasive infection. Mortality and inpatient stay was greater in VRE-positive compared with VRE-negative patients (50% versus 10%) and patients who were screened on three or more occasions were likely to remain positive (e.g. 56% of patients screened on six occasions were positive). The application of recommended guidelines for the control of VRE, however, severely disrupted our renal dialysis programme and therefore had to be abandoned. As patients on renal dialysis are more likely to acquire VRE, remain colonized, require antibiotics and require regular inpatient or outpatient care more frequently than other patients, control measures should be adapted to minimize spread but not disrupt important and essential medical services.
Subject(s)
Carrier State , Disease Outbreaks/prevention & control , Enterococcus , Gram-Positive Bacterial Infections/prevention & control , Renal Dialysis , Vancomycin Resistance , Adolescent , Adult , Aged , Aged, 80 and over , Carrier State/epidemiology , Child , Gram-Positive Bacterial Infections/epidemiology , Humans , Ireland/epidemiology , Middle Aged , Multivariate Analysis , Risk FactorsABSTRACT
The results of the first national incidence study of noninstitutionalized elder abuse and neglect in the United States are reviewed, as well as underlying causes of abusive relationships involving the elderly. It is estimated that approximately 1% to 2% of elders living in their own homes became abused in the United States during 1996, physically, emotionally, sexually, and/or financially. The abusers were predominantly adult children, spouses, and other relatives. More than 5 times as many new incidents of abuse and neglect were unreported than those reported to authorities responsible for addressing elder abuse. An individual who abuses an elder is often financially dependent on the elder, violent in other contexts, abuses alcohol and/or drugs, and has psychological problems. Although current rules and practices constrain the underwriting professional's use of this information in risk selection, public demand for financial institutions' reporting of elder abuse may provide an opportunity for open discussion about responsible handling of such cases.
