Skip to main content
SpringerLink
Log in

Predictive Factors of In-Hospital Mortality in Older Adults with Community-Acquired Bloodstream Infection

  • Original Research
  • Published:
The Journal of Frailty & Aging Aims and scope Submit manuscript

Abstract

Objectives

To assess the prevalence of intra-hospital mortality and associated risk factors in older people aged 75+, admitted with blood stream infections (BSI). Design: Single center retrospective study performed in an 850-bed of the academic hospital of the Université Libre de Bruxelles.

Setting and Participants

From January 2015 to December 2017, all inpatients over 75 years old admitted with BSI were included.

Measures

Demographical, clinical and microbiological data were collected.

Results

212 patients were included: median age was 82 [79–85] years and 60% were female. The in-hospital mortality rate was 19%. The majority of microorganisms were Gram-negative strains, of which Escherichia coli was the most common, and urinary tract infection was the most common origin of BSI. Compared to patients who survived, the non-survivor group had a higher SOFA score (6 versus 3, p<0.0001), a higher comorbidity score (5 versus 4, p<0.0001), more respiratory tract infections (28 vs 6%, p < 0.0001) and fungal infections (5 vs 1%, p = 0.033), bedridden status (60 vs 25%, p < 0.0001), and healthcare related infections (60 vs 40%, p = 0.019). Using Cox multivariable regression analysis, only SOFA score was independently associated with mortality (HR 1.75 [95%IC 1.52–2.03], p<0.0001).

Conclusions and Implications

BSI in older people are severe infections associated with a significant in-hospital mortality. Severity of clinical presentation at onset remains the most important predictor of mortality for BSI in older people. BSI originating from respiratory source and bedridden patients are at greater risk of intra-hospital mortality. Further prospective studies are needed to confirm these results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. Yahav D, Eliakim-Raz N, Leibovici L, Paul M. Bloodstream infections in older patients. Virulence 2016;7:341–352. doi: https://doi.org/10.1080/21505594.2015.1132142.

    Article  Google Scholar 

  2. Skogberg K., Lyytikainen O., Ollgren J., Nuorti J.P., Ruutu P. Population-based burden of bloodstream infections in Finland. Clin Microbiol Infect. 2012; 18(6):E170–E176.

    Article  CAS  Google Scholar 

  3. Htwe T.H., Mushtaq A., Robinson S.B., Rosher R.B., and Khardori N. Infection in the elderly. Infect. Dis. Clin. North Am 2007; 21:711–743: ix. https://doi.org/10.1016/j.idc.2007.07.006.

    Article  Google Scholar 

  4. Gavazzi G, Krause KH. Ageing and infection. Lancet Infect Dis 2002; 2(11):659–66; PMID:12409046; https://doi.org/10.1016/S1473-3099(02)00437-1.

    Article  Google Scholar 

  5. Berman P, Hogan DB, Fox RA. The atypical presentation of infection in old age. Age Ageing 1987; 16:201–207. doi:https://doi.org/10.1093/ageing/16.4.201.

    Article  CAS  Google Scholar 

  6. van Duin D. Diagnostic challenges and opportunities in older adults with infectious diseases. Clin Infect Dis. 2012; 54:973–978.

    Article  Google Scholar 

  7. Hernandez C, Feher C, Soriano A, Marco F, Almela M, Cobos-Trigueros N, De La Calle C, Morata L, Mensa J, Martİnez JA. Clinical characteristics and outcome of elderly patients with community-onset bacteremia. J Infect 2015; 70(2):135–43; https://doi.org/10.1016/j.jinf.2014.09.002

    Article  Google Scholar 

  8. Lee CC, Chen SY, Chang IJ, Chen SC, Wu SC. Comparison of clinical manifestations and outcome of community-acquired bloodstream infections among the oldest old, elderly, and adult patients. Med 2007; 86(3): 138–44; https://doi.org/10.1097/SHK.0b013e318067da56.

    Google Scholar 

  9. Sogaard M, Schonheyder HC, Riis A, Sorensen HT, Norgaard M. Short-term mortality in relation to age and comorbidity in older adults with community-acquired bacteremia: a population-based cohort study. J Am Geriatrics Society 2008; 56(9):1593–600; https://doi.org/10.1111/j.1532-5415.2008.01855.x.

    Article  Google Scholar 

  10. Reunes S, Rombaut V, Vogelaers D, Brusselaers N, Lizy C, Cankurtaran M, Labeau S, Petrovic M, Blot S. Risk factors and mortality for nosocomial bloodstream infections in elderly patients. Eur J Int Med 2011; 22(5):e39–44; https://doi.org/10.1016/j.ejim.2011.02.004.

    Article  CAS  Google Scholar 

  11. Blot S, Cankurtaran M, Petrovic M, Vandijck D, Lizy C, Decruyenaere J, Danneels C, Vandewoude K, Piette A, Vershraegen G, et al. Epidemiology and outcome of nosocomial bloodstream infection in elderly critically ill patients: a comparison between middle-aged, old, and very old patients. Critical Care Med 2009; 37(5): 1634–41; https://doi.org/10.1097/CCM.0b013e31819da98e.

    Article  Google Scholar 

  12. Goto M, Al-Hasan MN. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin Microbiol Infect. 2013;19(6):501–509. doi: https://doi.org/10.1111/1469-0691.12195.

    Article  CAS  Google Scholar 

  13. Leibovici L, Pitlik SD, Konisberger H, Drucker M. Bloodstream infections in patients older than eighty years. Age Ageing 1993; 22(6):431–42; https://doi.org/10.1093/ageing/22.6.431.

    Article  CAS  Google Scholar 

  14. Wester AL, Dunlop O, Melby KK, Dahle UR, Wyller TB. Age-related differences in symptoms, diagnosis and prognosis of bacteremia. BMC Infect Dis 2013; 13:346; https://doi.org/10.1186/1471-2334-13-346.

    Article  Google Scholar 

  15. Greenberg BM, Atmar RL, Stager CE, Greenberg SB. Bacteraemia in the elderly: predictors of out- come in an urban teaching hospital. J Infect 2005; 50(4):288–95; https://doi.org/10.1016/j.jinf.2004.06.014.

    Article  Google Scholar 

  16. Horan T. C., Andrus M., Dudeck M. A. (2008). CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008 36, 309–332. Doi:https://doi.org/10.1016/j.ajic.2008.03.002

    Article  Google Scholar 

  17. Vincent J-L, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. Intensive Care Med. 1996;22:707–710. doi: https://doi.org/10.1007/BF01709751.

    Article  CAS  Google Scholar 

  18. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.

    Article  CAS  Google Scholar 

  19. Cardoso T., Almeida M., Friedman N. D., et al. Classification of healthcare-associated infection: a systematic review 10 year after the first proposal. BMC Medicine 2014;12, article 40.

  20. Magiorakos A.P., Srinivasan A., Carey R.B., Carmeli Y., Falagas ME., Giske CG., et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin. Microbiol. Infect 2012; 18: 268–281. https://doi.org/10.1111/j.1469-0691.2011.03570.x.

    Article  CAS  Google Scholar 

  21. Nicolle LE. Urinary Tract Infections in the Older Adult. Clin Geriatr Med. 2016; 32:523–538. https://doi.org/10.1016/j.cger.2016.03.002.

    Article  Google Scholar 

  22. Jerkeman M, Braconier JH. Bacteremic and non-bacteremic febrile urinary tract infection, a review of 168 hospital-treated patients. Infection 1992; 20:143–145. PMID: 1644489.

    Article  CAS  Google Scholar 

  23. Artero A, Esparcia A, Eiros JM, Madrazo M, Alberola J, Nogueira JM. Effect of Bacteremia in Elderly Patients with Urinary Tract Infection. Am J Med Sci. 2016; 352:267–271. https://doi.org/10.1016/j.amjms.2016.05.031

    Article  Google Scholar 

  24. Artero A, Inglada L, Gómez-Belda A, Capdevila JA, Diez LF, Arca A, Romero JM, Domínguez-Gil M, Serra-Centelle SC, de la Fuente. The clinical impact of bacteremia on outcomes in elderly patients with pyelonephritis or urinary sepsis: A prospective multicenter study. PLoS One. 2018; 24;13(1):e0191066. doi: https://doi.org/10.1371/journal.pone.0191066.

    Article  Google Scholar 

  25. Rodriguez-Bano J, Picon E, Gijon P, et al. Community-onset bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli: risk factors and prognosis. Clin Infect Dis 2010;50:40–8.

    Article  CAS  Google Scholar 

  26. Byl B, Clevenbergh P, Jacobs F, Struelens MJ, Zech F, Kentos A, et al. Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia. Clin Infect Dis (1999) 29:60–6. https://doi.org/10.1086/520182

    Article  CAS  Google Scholar 

  27. Gavazzi G, Escobar P, Olive F, Couturier P, Franco A. Nosocomial bacteremia in very old patients: predictors of mortality. Aging Clin Exp Res 2005; 17(4):337–42. https://doi.org/10.1007/BF03324619

    Article  Google Scholar 

  28. Deulofeu F, Cervello B, Capell S, Marti C, Mercade V. Predictors of mortality in patients with bacteremia: the importance of functional status. J Am Geriatrics Society 1998; 46(1):14–8; https://doi.org/10.1111/j.1532-5415.1998.tb0100

    Article  CAS  Google Scholar 

  29. Waterer G.W., Wunderink R.G. The influence of the severity of community-acquired pneumonia on the usefulness of blood cultures. Respir. Med. 2001;95:78–82. doi: https://doi.org/10.1053/rmed.2000.0977

    Article  CAS  Google Scholar 

  30. https://his.wiv-isp.be/fr/Documents%20partages/HO_FR_2013.pdf

Download references

Acknowledgements

Professor Doctor Christian Melot, (Emergency Department, CUB Erasme, Brussels, Belgium) and Professor Judith Racapé (Biostatistics Department, CUB Erasme, Brussels, Belgium)

Author information

Authors and Affiliations

  1. Department of Geriatric Medicine, CUB-Erasme, Brussels, Belgium

    Davide Angioni & S. De Breucker

  2. Infectious Diseases Clinic, CUB-Erasme, Brussels, Belgium

    M. Hites & F. Jacobs

  3. Hopital Erasme, Gériatrie, Brussels, Belgium

    Davide Angioni

Authors
  1. Davide Angioni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Hites
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Jacobs
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. De Breucker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Davide Angioni.

Ethics declarations

Conflicts of Interest: The author(s) declare(s) that there is no conflict of interest regarding the publication of this article.

Ethical standards: All procedures followed were in accordance with the ethical standards.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Angioni, D., Hites, M., Jacobs, F. et al. Predictive Factors of In-Hospital Mortality in Older Adults with Community-Acquired Bloodstream Infection. J Frailty Aging 9, 232–237 (2020). https://doi.org/10.14283/jfa.2019.45

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.14283/jfa.2019.45

Key words

Search

Navigation