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Bloodstream infections in older population: epidemiology, outcome, and impact of multidrug resistance

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Abstract

Bloodstream infections (BSIs) among older patients are frequent with high rate of mortality. Infections with multidrug-resistant organisms (MDRO) are associated with higher mortality than with susceptible microorganisms. We aimed to evaluate the prevalence of MDRO infection during BSI in older population and the factors associated with unfavorable outcome. This study is a retrospective cohort of all BSI episodes occurring among older patients (> 65yo), from April 1, 2010, to December 31, 2016, in a French university hospital for geriatric medicine. A total of 255 BSI episodes were analyzed. Mean age was 86.3±6.5 years, and sex ratio (M/F) was 0.96. Main comorbidities were orthopedic device (26.7%), active neoplasia (24.3%), and diabetes mellitus (18.4%). Main primary sites of infection were urinary tract infections (56.9%), respiratory tract infections (10.6%), intra-abdominal infections (7.1%), and skin and soft tissue infections (4.7%). Main bacteria identified were Escherichia coli (45.1%), Staphylococcus aureus (14.1%), enterococci (10.7%), coagulase-negative staphylococci (CoNS) (5.5%), and streptococci (5.1%). MDROs were involved in 17.2% of BSI (gram-negative bacilli: 9.0%; CoNS: 4.3%; and methicillin-resistant S. aureus (MRSA): 3.9%). The main factor associated with MDRO BSI was colonization with MDRO (OR=6.29; 95%CI=2.9–14.32). Total mortality was 18.4% and significantly higher in case of initial severity (OR=3.83; 95%CI=1.75–8.38), healthcare-associated infection (OR=5.29; 95%CI=1.11–25.30), and MRSA BSI (OR=9.16; 95%CI=1.67–50.16). BSI due to MDRO is frequent in older population and is strongly associated with carriage of MDRO. Healthcare-associated BSI, severe episodes, and BSI due to MRSA are associated with unfavorable outcome. In these cases, a broad-spectrum antibiotic should be promptly initiated.

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Data Availability

The datasets analyzed during the study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Internal Medicine Department, Ambroise-Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France

    Marine de Laroche, Clara Duran & Aurélien Dinh

  2. Pharmacy Department, Sainte-Périne Hospital, AP-HP Paris Saclay University, Paris, France

    Lesly Fellous & Hugues Michelon

  3. Microbiology Laboratory, Ambroise-Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France

    Elsa Salomon & Jean-Louis Gaillard

  4. Faculty of Public Health, Lebanese University, Beirut, Lebanon

    Danielle Saadeh

  5. Pharmacy Department, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France

    Frédérique Bouchand & Hugues Michelon

  6. Geriatric Medicine Department, Sainte-Périne Hospital, AP-HP Paris Saclay University, Paris, France

    Jean-Laurent Lequintrec, Laurent Teillet & Zineb Seridi

  7. Geriatric Medicine Department, Ambroise-Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France

    Laurent Teillet

  8. Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, 104 Bd R. Poincaré, 92380, Garches, France

    Aurélien Dinh

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  1. Marine de Laroche
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Contributions

MdL and AD contributed to the study conception and design. Data collection was performed by MdL, LF, LL, ES, ZS, and HM. Statistical analyses were performed by DS and CD. The first draft of the manuscript was written by MdL, CD, FB, HM, and AD. CD and AD were responsible for writing–review and editing. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Aurélien Dinh.

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Due to its retrospective nature, no ethical approval was required. The research was conducted in accordance with the Declaration of Helsinki and national and institutional standards.

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No patient included in the study expressed opposition to the use of clinical data in this retrospective study.

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The authors declare no competing interests.

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de Laroche, M., Fellous, L., Salomon, E. et al. Bloodstream infections in older population: epidemiology, outcome, and impact of multidrug resistance. Eur J Clin Microbiol Infect Dis 40, 1665–1672 (2021). https://doi.org/10.1007/s10096-021-04212-7

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