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Impact of age in critically Ill infected patients: a post-hoc analysis of the INFAUCI study

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Key summary points

AbstractSection Aim

Address the epidemiology and the main determinants of outcome of infection in old and very old patients admitted to ICU.

AbstractSection Findings

Patients > 65years represented 50% of all infected ICU patients of our sample. Increasing age was associated to higher all-cause mortality and to infection by Gram-negative bacteria but not by MDR bacteria.

AbstractSection Message

The present findings may optimize strategies for infection management in older patients, namely by adjusting initial empiric antibiotics.

Abstract

Purpose

Older patients are the fastest expanding subgroup of intensive care units (ICU) and are particularly susceptible to bacterial infections and sepsis. The aim of this study was to address the epidemiology and the main determinants of outcome of infection in old and very old patients admitted to ICU.

Methods

We performed a post hoc analysis of all infected patients admitted to ICU enrolled in a 1-year prospective, observational, multipurpose study. Patients aged < 65, 65–74 and ≥ 75 years were compared.

Results

Of the 1652 patients included, 50% were older than 65 years. There were no significant differences between young, old and very old patients in either ICU, hospital length of stay, or nosocomial infection. All-cause mortality was significantly higher in participants aged ≥ 75. Increased Gram-negative microorganisms’ isolates occurred in > 65 years (25% versus 31%; p = 0.034). Multidrug-resistant (MDR) microorganisms were directly associated to inappropriate empiric antibiotic therapy (OR 4.73; 95% CI 2.99–7.47) and inversely associated with community-acquired infection (OR 0.39; 95% CI 0.19–0.83). Age (65–74 years: OR 1.10; 95% CI 0.64–1.90 and ≥ 75 years: OR 1.52; 95% CI 0.89–2.59) and sepsis severity (sepsis: OR 0.67; 95% CI 0.18–2.46; severe sepsis: OR 1.17; 95% CI 0.40–3.44; septic shock: OR 0.77; 95% CI 0.27–2.24) were not associated to MDR bacteria.

Conclusion

Patients > 65 years accounted for 50% of infected patients admitted to an ICU. ICU and hospital length of stay, and nosocomial infection did not increase with age. Age did predispose to increased risk for infection by Gram-negatives. These findings may optimize strategies for infection management in older patients.

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Acknowledgements

Members of the INFAUCI study group: Conceição Sousa Dias, José Manuel Pereira, José-Artur Paiva, Serviço de Medicina Intensiva, Centro Hospitalar S. João (Porto); Lurdes Santos, Alcina Ferreira, UCI—Doenças Infecciosas, Centro Hospitalar S. João (Porto); Richard Maul, Serviço de Medicina Intensiva, Centro Hospitalar Funchal (Funchal); Vasco Tavares, Ana Josefina Mendes, Serviço de Cuidados Intensivos, Centro Hospitalar Vila Nova Gaia/Espinho (Gaia); Paulo Marçal, Piedade Amaro, Unidade de Cuidados Intensivos Polivalente, Centro Hospitalar Entre Douro e Vouga (Vila da Feira); Anabela Bartolo, Ruth Milheiro, Serviço de Cuidados Intensivos, Centro Hospitalar Alto Ave (Guimarães); Filomena Faria, Serviço de Cuidados Intensivos, Instituto Português de Oncologia-Norte (Porto); João Pedro Baptista, Eduardo Sousa, Serviço de Medicina Intensiva, Hospitais Universidade de Coimbra (Coimbra); Sofia Beirão, Ana Marques, Serviço de Medicina Intensiva, Centro Hospitalar Covões (Coimbra); Eduardo Melo, Unidade de Cuidados Intensivos Polivalente, Hospital São Teotónio (Viseu); João Gonçalves-Pereira, Joana Silvestre, Unidade de Cuidados Intensivos Polivalente, Hospital S. Francisco Xavier (Lisboa); Filipe Froes, Unidade de Cuidados Intensivos Respiratórios, Centro Hospitalar Lisboa Norte (Lisboa); Maria João Vilas, Unidade de Cuidados Intensivos, Hospital do Litoral Alentejano (Santiago do Cacém); José Vaz, Unidade de Cuidados Intensivos, Hospital José Joaquim Fernandes (Beja); Luís Bento, Unidade de Cuidados Intensivos Polivalente 2, Centro Hospitalar de Lisboa Central (Lisboa); Orquídea Ribeiro, Faculdade de Medicina da Universidade do Porto (Porto).

Funding

This work was supported by an unrestricted grant from GIS (Grupo de Infecção e Sepsis, Hospital de S. João, Porto, Portugal).

Author information

Authors and Affiliations

  1. Internal Medicine Service, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

    Sónia Bastos Moreira

  2. Intensive Care Service, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

    João Pedro Baptista

  3. Polyvalent Intensive Care Unit, Hospital Sao Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal

    João Gonçalves-Pereira

  4. Emergency and Intensive Care Department, Centro Hospitalar São João, Porto, Portugal

    José Manuel Pereira & José-Artur Paiva

  5. Faculty of Medicine, Universidade do Porto, Porto, Portugal

    José Manuel Pereira & José-Artur Paiva

  6. Grupo de Infecção e Sepsis, Porto, Portugal

    José Manuel Pereira & José-Artur Paiva

  7. Department of Health Information and Decision Sciences, Faculty of Medicine, Center for Research in Health Technologies and Information Systems, CINTESIS, Universidade Do Porto, Porto, Portugal

    Orquídea Ribeiro & Claúdia Camila Dias

  8. Respiratory Intensive Care Unit, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal

    Filipe Froes

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  1. Sónia Bastos Moreira
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Contributions

SBM and JPB drafted the manuscript and conducted the analysis. OR e CCD supervised data analysis. SBM, JG-P, JMP, JPB, FF and J-AP critically reviewed the manuscript and agreed with the final version and findings. The author (s) read and approved the final manuscript.

Corresponding author

Correspondence to Sónia Bastos Moreira.

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Conflict of interest

None of the authors have any competing interests in the manuscript.

Ethical approval and consent to participate

The Hospital Research and Ethics Committee of Centro Hospitalar São João approved the study design which has therefore been performed in accordance with ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was waived due to the observational nature of the study.

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OR takes responsibility for archiving the data.

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Moreira, S.B., Baptista, J.P., Gonçalves-Pereira, J. et al. Impact of age in critically Ill infected patients: a post-hoc analysis of the INFAUCI study. Eur Geriatr Med 12, 1057–1064 (2021). https://doi.org/10.1007/s41999-021-00470-y

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