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care (OR 1.93, 95% CI, 1.67-2.24 for high-risk antihistamines; OR
5.97, 95% CI 0.76-47.03 for high-risk cardiac drugs; OR 1.99, 95% CI
1.29-3.07 for psychotropics). Index exposure to high-risk cardiac
drugs also significantly increased musculoskeletal adverse outcomes
(OR 2.28, 95% CI 1.76-2.96) but incident exposure to psychotropics
did not significantly increase gastrointestinal adverse outcomes (OR
1.14, 95% CI 0.75-1.72). Conclusion: Incident exposure to HRME is
associated with adverse outcomes within one year following index
day in senior veterans with chronic pain. Further research is needed
to develop intervention measures to limit such exposure.
B39
Novel predictors of new antibiotic resistant organism (ARO)
colonization in nursing home (NH) residents.
L. Min, 1,2 L. Mody. 1,2 1. Medicine, University of Michigan, Ann Arbor,
MI; 2. GRECC, VA Health Care Systems, Ann Arbor, MI.
Supported By: Agency for Healthcare Quality and Research (Min),
VA Healthcare System Geriatric Research Clinical Care Center
(GRECC, Min and Mody), Hartford Foundation (Min), NIA-
Pepper Center (Min, Mody), NIH (K23AG028943 and
R01AG032298 Mody), NIH-LRP (Min), T Franklin Williams
(Mody).
Objective: NH residents with functional disability are at risk for
ARO colonization. We tested (1) whether function predicts AROs independent
of clinical risk factors (co-morbidities, wounds, hospitalization)
& (2) whether specific activities of daily living (ADLs) are
associated with higher risk due to greater nursing contact time (e.g.
feeding) or bodily exposure (e.g. toiling).
Methods: Longitudinal surveillance of 178 NH residents, half
with indwelling device, actively cultured at multiple anatomic sites at
baseline and every 30 days until discharge or 1 yr.
Outcomes: Time to new colonization for methicillin-resistant
Staphylococcus aureus (MRSA), vancomycin-resistant enterococci
(VRE), and resistant gram-negative bacteria (GNB-R). A new ARO
was defined as a positive culture following a negative previous culture
for that ARO. A patient could have multiple new colonizations if
negative cultures were collected in between positive ARO cultures.
Control variables (baseline): device, functional impairment (overall
vs 6 ADLs [Table]), co-morbidity (Charlson index [CCI] vs conditions
from CCI). Time-varying predictors: interval hospitalization or
wound/pressure ulcer. We modeled time to new ARO using multiplefailure
Cox proportional hazard models to allow for fluctuation in
colonization status.
Results: 111 had ≥2 visits (729 follow-up visits total). 76 had at
least 1 new ARO colonization, with multiple new colonizations occurring
in 51 residents.
Conclusions: Besides known risk factors such as hospitalization,
indwelling devices, and wounds, we identified contact-intense ADLs
such as assistance in feeding and walking & chronic conditions such
as heart failure and hemiparesis that predict new ARO colonization
in NH residents.
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