PDF(Pubmed)
Abstract：
UNASSIGNED: Bloodstream infection (BSI) is characterized by high mortality, especially among these increasing super-elderly patients (≥85 years), and this study was conducted to understand the species distribution, typical clinical features and risk factors for poor prognosis of super-elderly patients with BSI.
UNASSIGNED: Based on previous work, this retrospective study was performed by reviewing an ongoing prospective medical database in a comprehensive tertiary center in China, and all super-elderly patients with BSI in the past 6 years were enrolled in this study.
UNASSIGNED: Out of 5944 adult-patients with BSI, there were totally 431 super-elderly patients (≥85 years old) enrolled in this study and age ≥90 years accounted for 31.1% (134/431). Among these 431 super-elderly patients with BSI, 40 patients (9.3%) were diagnosed with BSI and the remained 401 super-elderly patients (90.7%) were defined as hospital-acquired BSI. The typical feature of these super-elderly patients with BSI was the high proportion of patients with various comorbidities, such as cardiovascular disease (83.8%), ischemic cerebrovascular disease (63.3%) and pulmonary infection (61.0%). The other typical feature was that most (60.1%) of these patients had been hospitalized for long time (≥28 days) prior to the onset of BSI, and most patients had received various invasive treatments, such as indwelling central venous catheter (53.1%) and indwelling urinary catheter (47.1%). Unfortunately, due to these adverse features above, both the 7-day short-term mortality (13.2%, 57/431) and the 30-day long-term mortality (24.8%, 107/431) were high. The multivariate analysis showed that both chronic liver failure (OR 7.9, 95% CI 2.3-27.8, P=0.001) and indwelling urinary catheter (OR 2.3, 95% CI 1.1-4.7, P=0.023) were independent risk factors for 7-day short-term mortality, but not for 30-day long-term mortality. In addition, the microbiology results showed that the most common species were associated with nosocomial infection or self-opportunistic infection, such as Staphylococcus hominis (18.3%), Staphylococcus epidermidis (11.8%), Escherichia coli (9.7%), Klebsiella pneumoniae (9.3%) and Candida albicans (8.6%, fungi).
UNASSIGNED: Super-elderly patients with BSI had typical features, regardless of the pathogenic species distribution and their drug resistance, or clinical features and their risk factors for poor prognosis. These typical features deserved attention and could be used for the prevention and treatment of BSI among super-elderly patients.
UNASSIGNED: Based on previous work, this retrospective study was performed by reviewing an ongoing prospective medical database in a comprehensive tertiary center in China, and all super-elderly patients with BSI in the past 6 years were enrolled in this study.
UNASSIGNED: Out of 5944 adult-patients with BSI, there were totally 431 super-elderly patients (≥85 years old) enrolled in this study and age ≥90 years accounted for 31.1% (134/431). Among these 431 super-elderly patients with BSI, 40 patients (9.3%) were diagnosed with BSI and the remained 401 super-elderly patients (90.7%) were defined as hospital-acquired BSI. The typical feature of these super-elderly patients with BSI was the high proportion of patients with various comorbidities, such as cardiovascular disease (83.8%), ischemic cerebrovascular disease (63.3%) and pulmonary infection (61.0%). The other typical feature was that most (60.1%) of these patients had been hospitalized for long time (≥28 days) prior to the onset of BSI, and most patients had received various invasive treatments, such as indwelling central venous catheter (53.1%) and indwelling urinary catheter (47.1%). Unfortunately, due to these adverse features above, both the 7-day short-term mortality (13.2%, 57/431) and the 30-day long-term mortality (24.8%, 107/431) were high. The multivariate analysis showed that both chronic liver failure (OR 7.9, 95% CI 2.3-27.8, P=0.001) and indwelling urinary catheter (OR 2.3, 95% CI 1.1-4.7, P=0.023) were independent risk factors for 7-day short-term mortality, but not for 30-day long-term mortality. In addition, the microbiology results showed that the most common species were associated with nosocomial infection or self-opportunistic infection, such as Staphylococcus hominis (18.3%), Staphylococcus epidermidis (11.8%), Escherichia coli (9.7%), Klebsiella pneumoniae (9.3%) and Candida albicans (8.6%, fungi).
UNASSIGNED: Super-elderly patients with BSI had typical features, regardless of the pathogenic species distribution and their drug resistance, or clinical features and their risk factors for poor prognosis. These typical features deserved attention and could be used for the prevention and treatment of BSI among super-elderly patients.
摘要：
■血流感染（BSI）的特点是死亡率高，特别是在这些不断增加的超老年患者(≥85岁)中，这项研究是为了了解物种分布，超老年BSI患者典型临床特征及预后不良的危险因素。
■根据以前的工作，这项回顾性研究是通过回顾中国综合三级中心正在进行的前瞻性医学数据库来进行的，过去6年中所有患有BSI的超老年患者均纳入本研究。
■在5944名成人BSI患者中，本研究共纳入431例超高龄患者(≥85岁),年龄≥90岁占31.1%(134/431).在这431名超老年BSI患者中，40名患者（9.3％）被诊断为BSI，其余401名超老年患者（90.7％）被定义为医院获得的BSI。这些超老年BSI患者的典型特征是各种合并症患者比例高，如心血管疾病（83.8%），缺血性脑血管病(63.3%)和肺部感染(61.0%)。另一个典型特征是，这些患者中的大多数（60.1%）在BSI发作前已经住院很长时间（≥28天），大多数患者接受了各种侵入性治疗，如留置中心静脉导管(53.1%)和留置导尿管(47.1%)。不幸的是,由于上述这些不利特征，两者都是7天短期死亡率(13.2%，57/431）和30天长期死亡率（24.8%，107/431）高。多因素分析显示，慢性肝衰竭（OR7.9，95％CI2.3-27.8，P=0.001）和留置导尿管（OR2.3，95％CI1.1-4.7，P=0.023）是7天短期死亡的独立危险因素。但不是30天的长期死亡率。此外,微生物学结果表明，最常见的物种与医院感染或自我机会性感染有关，如葡萄球菌（18.3%），表皮葡萄球菌(11.8%),大肠杆菌(9.7%),肺炎克雷伯菌(9.3%)和白色念珠菌(8.6%,真菌)。
■患有BSI的超老年患者具有典型特征，无论病原物种分布及其耐药性如何，或临床特征及其预后不良的危险因素。这些典型特征值得关注，可用于超老年患者BSI的预防和治疗。
■根据以前的工作，这项回顾性研究是通过回顾中国综合三级中心正在进行的前瞻性医学数据库来进行的，过去6年中所有患有BSI的超老年患者均纳入本研究。
■在5944名成人BSI患者中，本研究共纳入431例超高龄患者(≥85岁),年龄≥90岁占31.1%(134/431).在这431名超老年BSI患者中，40名患者（9.3％）被诊断为BSI，其余401名超老年患者（90.7％）被定义为医院获得的BSI。这些超老年BSI患者的典型特征是各种合并症患者比例高，如心血管疾病（83.8%），缺血性脑血管病(63.3%)和肺部感染(61.0%)。另一个典型特征是，这些患者中的大多数（60.1%）在BSI发作前已经住院很长时间（≥28天），大多数患者接受了各种侵入性治疗，如留置中心静脉导管(53.1%)和留置导尿管(47.1%)。不幸的是,由于上述这些不利特征，两者都是7天短期死亡率(13.2%，57/431）和30天长期死亡率（24.8%，107/431）高。多因素分析显示，慢性肝衰竭（OR7.9，95％CI2.3-27.8，P=0.001）和留置导尿管（OR2.3，95％CI1.1-4.7，P=0.023）是7天短期死亡的独立危险因素。但不是30天的长期死亡率。此外,微生物学结果表明，最常见的物种与医院感染或自我机会性感染有关，如葡萄球菌（18.3%），表皮葡萄球菌(11.8%),大肠杆菌(9.7%),肺炎克雷伯菌(9.3%)和白色念珠菌(8.6%,真菌)。
■患有BSI的超老年患者具有典型特征，无论病原物种分布及其耐药性如何，或临床特征及其预后不良的危险因素。这些典型特征值得关注，可用于超老年患者BSI的预防和治疗。
