Risk Factors for Mortality Among Older Adults with Hospital-Acquired Bloodstream Infections in the Intensive Care Unit: A Multicenter Cohort Study.

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES Infectious Diseases and Therapy Pub Date : 2025-01-11 DOI:10.1007/s40121-024-01104-z

Tomer Hoffman, Ili Margalit, Alexis Tabah, Stéphane Ruckly, François Barbier, Pierre Singer, Jean-François Timsit, Virginie Prendki, Nasreen Hassoun-Kheir, Niccolò Buetti, Dafna Yahav

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Abstract

Introduction: We aimed to investigate risk factors for mortality among older adults (≥ 75 years) with hospital-acquired bloodstream infections (HA-BSI) in the intensive care unit (ICU).

Methods: We included patients aged ≥ 75 years with HA-BSI in ICU from the EUROBACT-2 cohort (2019-2021). Univariable and multivariable analyses were conducted to identify predictors of 28-day mortality.

Results: The cohort included 563 patients (median age 80, 39% women). Mortality at 28 day was 50%. Factors associated with mortality in multivariate analysis were admission due to COVID-19, failure to achieve source control, and higher SOFA. Among older adults with Gram-negative BSI, corticosteroid administration for septic shock was an additional factor. Among functionally independent patients, age itself was not associated with mortality.

Conclusions: HA-BSI in older adults in ICU are associated with high mortality. Inadequate source control is a significant modifiable risk factor. The use of corticosteroids in ICU management of older adults should be further investigated.

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重症监护病房住院获得性血液感染老年人死亡的危险因素：一项多中心队列研究

前言：我们的目的是调查重症监护病房（ICU）中患有医院获得性血液感染（HA-BSI）的老年人（≥75岁）死亡率的危险因素。方法：我们纳入了来自EUROBACT-2队列（2019-2021）的ICU年龄≥75岁HA-BSI患者。进行单变量和多变量分析以确定28天死亡率的预测因素。结果：该队列包括563例患者（中位年龄80岁，39%为女性）。28天死亡率为50%。在多因素分析中，与死亡率相关的因素是因COVID-19入院、未能实现源头控制和较高的SOFA。在革兰氏阴性BSI的老年人中，使用皮质类固醇治疗感染性休克是另一个因素。在功能独立的患者中，年龄本身与死亡率无关。结论：ICU老年人HA-BSI与高死亡率相关。源头控制不足是一个重要的可改变的风险因素。皮质类固醇在老年人ICU管理中的应用有待进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infectious Diseases and Therapy Medicine-Microbiology (medical)

CiteScore

8.60

自引率

1.90%

发文量

136

审稿时长

6 weeks

期刊介绍： Infectious Diseases and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of infectious disease therapies and interventions, including vaccines and devices. Studies relating to diagnostic products and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, bacterial and fungal infections, viral infections (including HIV/AIDS and hepatitis), parasitological diseases, tuberculosis and other mycobacterial diseases, vaccinations and other interventions, and drug-resistance, chronic infections, epidemiology and tropical, emergent, pediatric, dermal and sexually-transmitted diseases.