Prospective survey of the incidence, risk factors and outcome of hospital-acquired infections in the elderly (original) (raw)
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Hospital-Acquired Infections in Elderly Versus Younger Patients in an Acute Care Hospital
International Journal of Infection, 2015
Background: A growing number of elderly patients are hospitalized for various causes and age has been described inconsistently as a risk factor for acquiring nosocomial infections with a subsequent higher mortality rate compared to younger patients. Objectives: To describe the incidence, type, and microbiological characteristics of nosocomial infections in elderly and non-elderly patients. Patients and Methods: Retrospective analysis of all hospital-acquired infections (HAIs) in an academic community hospital. Patients were stratified into two groups: non-elderly (18-64 years) and elderly (> 65 years). Results: A total of 18469 patients were included (108555 hospital days) in this study. About 79.6% of HAI were infected non-elderly and 20.3% elderly (P < 0.0001) patients. Higher infection rates for ventilator-associated pneumonia (VAP), secondary bacteremia, and catheterassociated urinary tract infections were noted for elderly as well as a higher frequency of positive cultures for Gram-negative bacteria, particularly Klebsiella spp. and fungal infections (P > 0.05). Hospital mortality increased with every HAI diagnosed per patient. Conclusions: The study showed that HAIs were more frequent in elderly population predominately with respect to VAP and infections by Gram-negative pathogens. Overall mortally was greater in the elderly group although the odds ratio for death was higher in younger patients and increased with every HAI diagnosed.
Internal and Emergency Medicine, 2019
In older adults infections are among the leading causes of emergency department visits, hospitalization, morbidity and mortality [1–3]. Infections also occur as adverse events during hospitalization, as highlighted by the large use of antibiotics in this setting, resulting in an increase of hospitalization length and mortality rate [4–6]. There is a paucity of studies, especially in European countries, that did offer a general pattern on all the types of infections occurring in acutely hospitalized older patients, being the literature mainly focused on single type of infections (i.e. pneumonia and urinary tract infections). To fill this gap of knowledge, we chose to observe and describe the prevalence and types of infections in a large cohort of older hospitalized patients in the frame of REPOSI (REgistro POliterapie SIMI) register. REPOSI is a collaborative register that involves a large number of Italian internal medicine and geriatric wards. Briefly, patients aged 65 years or mor...
Infections in elderly intensive care unit patients
Journal of Emergency and Critical Care Medicine, 2019
The elderly population is increasing in the developed world, therefore elderlies account for a considerable proportion of intensive care unit (ICU) admissions. A precise threshold for "elderly" is a matter of debate. The process of ageing is associated with physiological and functional alterations of the human body and organs that render elderly people vulnerable to infections. As a result of dysfunction of specific parts of immune response called immunosenescence, elderly patients may be threatened by severe infections. Chronic low-grade inflammation, termed inflammaging, is another contributor. In addition to these, comorbidities associated with increasing age, such as diabetes mellitus and immunosuppressive conditions pose an additive risk for infections and in some studies they were associated with increased mortality. Epidemiology of ICU infections may differ in elderlies, compared to other adults. Infections tend to be less microbiologically confirmed and site of infection may be obscure on presentation. The identified pathogens are frequently Gram-negative and particularly Enterobacteriaceae exhibiting a multidrug-resistant (MDR) phenotype. Multiple antibiotic prescriptions in this age-group, specific comorbidities (such as bronchiectasis or chronic obstructive pulmonary disease), residence in long term care facilities and frequent hospitalisations, are among others recognized risk factors for MDR infections. Data from two large European databases show that intra-abdominal infections are predominant among ICU infections in the elderly and Candida spp infections rank second, after Enterobacteriaceae. Age may pose important implications in treatment decisions. Organ derangements, physiological changes caused by increasing age and multiple concomitant medications call clinicians for vigilance about adverse events and toxicity. Despite all the above, elderlies in the ICU did not exhibit worse outcomes compared to younger counterparts in a straightforward manner. Studies however are heterogenous and most of them are single centers. As age is a continuous process, only analysis performed in subgroups of 65-74 (young-old elderlies), 75-84 (old elderlies) and >85 (old-old or oldest old elderlies) provides a better depiction of ICU outcomes. Most studies have shown a worse ICU outcome for the group of oldest-old elderlies, compared with young adults and elderlies in the range of 65 to 84 years of age. These data indicate that age per se may not represent a barrier in decisions concerning ICU admission and triage has to be done on an individual basis. However, epidemiological particularities of this age group should be taken into account in the selection of early and appropriate antimicrobial treatment, which will optimize patients' outcomes.
Hospital-acquired infections and antibiotic use in a geriatric hospital: a point prevalence study
Background: Healthcare-Associated Infections (HAIs) are the most common healthcareassociated complications, particularly in elderly patients. The aim of this study is to describe the prevalence of HAIs and associated risk factors in the IRCCS INRCA of Ancona. Methods: A cross-sectional study has been carried out. Data has been collected in accordance with the European Centre for Disease Prevention and Control (ECDC) Point Prevalence Survey 2022-2023 (PPS3) protocol in the IRCCS INRCA of Ancona in November 2022. Results: Out of the 128 patients included in our study, 75.0% were over 78 years old and 9.1% presented an active HAI on the day of the survey. The prevalence of HAIs varied based on the length of the hospital stay (OR 1.1, CI 95% 1.05-1.17, p < 0.001) and hospitalization > 7 days (OR 5.9, CI 95% 1.2-28.7, p = 0.02). Conclusion: It is clear from our fi ndings that HAIs are associated with advanced patient age, prolonged hospital stay, and use of medical devices, especially in those patients that, due to their clinical situation, are more vulnerable. Although some of these infections can easily be treated, it is important to develop eff ective infection control strategies thanks to antimicrobial stewardship programs.
International Journal of Environmental Research and Public Health, 2021
Demographic studies show that life expectancy is increasing in developed countries; increased longevity has also increased the share of the older population with often concomitant chronic conditions. An ageing population and increased comorbidities lead to more complex pharmacological therapies (polypharmacy). The particular picture provided by chronic conditions and polypharmacy can lead to longer hospital stays and a greater need for healthcare. Elderly patients are identified as being in the high-risk group for the development of healthcare-associated infections (HAIs) due to the age-related decline of the immune system, known as immunosenescence. Comorbid conditions can often complicate infections, diminishing our ability to treat them effectively. Respiratory tract infections are the most common healthcare-associated infections, followed by urinary tract infections. HAIs in geriatric patients are responsible for longer hospital stays, extended antibiotic therapy, significant mo...
Healthcare-associated infections in the elderly
Current Opinion in Infectious Diseases, 2016
Purpose of review The high-risk population and current lack of knowledge regarding appropriate infection prevention in the long-term care (LTC) setting has contributed to substantial rates of resistance and healthcare-associated infections in this arena. More evidence-based research on LTC is necessary, particularly now that the elderly population is increasing. Recent findings Proposed government mandates highlight the urgent need to combat antimicrobial resistance in the LTC setting. Recent studies focusing on unique strategies for the prevention of transmission and infection with multidrug-resistant organisms in nursing homes are discussed, as well as attempts to formulate clear antimicrobial stewardship programs.
Deaths among the elderly with ICU infections
Revista Brasileira de Enfermagem
Objective: to evaluate the clinical outcome of elderly patients admitted to intensive care units who had nosocomial infection, correlating the findings with sociodemographic and clinical variables. Method: descriptive research, performed with 308 elderly patients. The collection was made from medical records and covers the years 2012 to 2015. Uni-/bivariate analyses were performed. Results: a statistical association was found between the clinical outcome types and the variables age, length of stay, presence of previous comorbidities, main diagnosis, respiratory and urinary tract infections, use of central venous and indwelling urinary catheters, mechanical ventilation, and tracheostomy. The survival curve showed higher mortality among the elderly from the age of 80 on. Conclusion: the clinical outcome of the elderly who acquire infection in the intensive care unit is influenced by sociodemographic and clinical variables that increase mortality rates.