Clinical Analysis of Hospital-acquired Bloodstream Infection in the Elderly

Authors

  • Baojun Sun the Township Hospital of Longwantunn Town, Shunyi District, Beijing, 101306 China

DOI:

https://doi.org/10.30564/jgm.v1i01.728

Abstract

Objective: This study was designed to get epidemiological characteristics, etiology characteristics, prognosis assessment and prognostic factors of hospital-acquired bloodstream infection (HABSI) in the elderly in Chinese PLA General Hospital and aimed at providing a reference for HABSI in the elderly on clinical diagnosis and treatment to improve the prognosis. Methods: The clinical data and pathology data of 210 cases of the elderly patients with HABSI from 2009 to 2012 in geriatric wards were retrospectively analyzed. Compare the clinical assessment effects of APACHE-II score, SAPS-II score and SOFA score to HABSI prognosis in the elderly by plotting the receiver operating characteristic curve. Use univariate and multivariate logistic regression analysis to get prognostic factors of HABSI in the elderly. Results: Univariate analysis of mortality: Day 1 apache -> 18 II score, lung infection, invasive ventilation, chronic hepatic insufficiency, chronic renal insufficiency, substantive organ malignant tumor, deep venipuncture, indwelling gastric tube indwelling ureter, complicated with shock and acquired bloodstream infections in the elderly patients with 7 days survival state association is significant. Day-1 SOFA score>7, chronic liver dysfunction, chronic renal insufficiency, concurrent shock, hemodialysis and 28-day survival status of patients with acquired bloodstream infection in elderly hospitals were significantly associated. Multivariate unconditioned logistic regression analysis related to death: Day-1APACHE-II score>18, parenchymal malignant tumors, and concurrent shock are independent risk factors for 7-day death in elderly patients with acquired bloodstream infection. Day-1 SOFA score>7, chronic renal insufficiency, and concurrent shock are independent risk factors for 28-day mortality in elderly patients with acquired bloodstream infection. Conclusion: The incidence of acquired bloodstream infections in the elderly was 1.37%. The 7-day and 28-day mortality rates were 8.10% and 22.38%, respectively. Concurrent shock is 26.7%. The 28-day mortality rate of concurrent shock patients was 48.21%. The best outcome score for the 7-day prognosis of elderly patients with acquired bloodstream infection was the Day-1APACHE-II score, followed by the Day-1 SOFA score. The best score for the 28-day prognostic assessment was the Day-1 SOFA score.

Keywords:

Elderly, Hospital-acquired bloodstream infection, Etiology, Prognosis

References

[1] Warren DK, Quadir WW, Hollenbeak CS, et al. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital. Crit Care Med. 2006, 34(8): 2084-9.

[2] KB Laupland, PC Kibsey, DB Gregson, et al. Population-based laboratory assessment of the burden of community-onset bloodstream infection in Victori, Canada. Epidemiol Infect. 2013, 141(1): 174-80.

[3] Andrew Stewardson, Carolina Fankhauser, Giulia De Angelis, et al. Burden of Bloodstream Infection Caused by Extended-Spectrum b-Lactamase–Producing Enterobacteriaceae Determined Using Multistate Modeling at a Swiss University Hospital and a Nationwide Predictive Model. Infect Control Hosp Epidemiol. 2013, 34(2): 133-43.

[4] Brun-Buisson C, Meshaka P, Pinton P, et al. EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med. 2004, 30(4): 580-8.

[5] Sagana R, Hyzy RC. Achieving Zero Central Line–associated Bloodstream Infection Rates in Your Intensive Care Unit. Crit Care Clin. 2013, 29(1): 1-9.

[6] Angus DC, Linde-Zwirble WT, Lidicker J, et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001, 29(7): 1303-10.

[7] Bueno-Cavanillas A, Delgado-Rodrıguez M, Lopez-Luque A, et al. Influence of nosocomial infection on mortality rate in an intensive care unit. Crit Care Med. 1994, 22(1): 55-60.

[8] Del PJ. Role of antibiotic lock therapy for the treatment of catheter-related bloodstream infections. Int J Artif Organs. 2009, 32(9): 678-88.

[9] Touré A, Vanhems P, Lombard-Bohas C, et al. Is diabetes a risk factor for central venous access port-related bloodstream infection in oncological patients? Eur J Clin Microbiol Infect Dis. 2013, 32(1): 133-8.

[10] Zuyao Yang, Siyan Zhan, Handbo Zhao, et al. Systematic evaluation and meta-analysis of in-hospital mortality of bloodstream infections in China. Journal of Peking University (Medical Edition). 2010,42(3):304-307.

[11] Godfrey DI, Macdonald HR, Kronenberg M, et al. NKT cells: what's in a name? Nat Rev Immunol. 2004, 4(3): 231-7.

[12] Vallés J, Ferrer R. Bloodstream infection in the ICU. Infect Dis Clin North Am. 2009, 23(3): 557-69.

[13] Ministry of Health of the PRC. Diagnostic criteria for nosocomial infections (trial). Chinese Medical Journal. 2001,81(5):314-320.

[14] van der Kooi TI, Wille JC, van Benthem BH. Catheter application, insertion vein and length of ICU stay prior to insertion affect the risk of catheter-related bloodstream infection. J Hosp Infect. 2012, 80(3): 238-44.

[15] Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc. 2006, 81(9): 1159-71.

[16] Liaw CC, Chen JS, Chang HK, et al. Symptoms and signs of port-related infections in oncology patients related to the offending pathogens. Int J Clin Pract. 2008, 62(8): 1193-8.

[17] Chang L, Tsai JS, Huang SJ, et al. Evaluation of infectious complications of the implantable venous access system in a general oncologic population. Am J Infect Control. 2003, 31(1): 34-9.

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How to Cite

Sun, B. (2019). Clinical Analysis of Hospital-acquired Bloodstream Infection in the Elderly. Journal of Geriatric Medicine, 1(1), 8–14. https://doi.org/10.30564/jgm.v1i01.728

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