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Comparative Study
. 2024 Dec;52(6):2435-2443.
doi: 10.1007/s15010-024-02304-y. Epub 2024 Jun 13.

Presentation, management, and outcomes of older compared to younger adults with hospital-acquired bloodstream infections in the intensive care unit: a multicenter cohort study

Ili Margalit  1   2 , Dafna Yahav  3   4 , Tomer Hoffman  3   4 , Alexis Tabah  5   6   7 , Stéphane Ruckly  8   9 , François Barbier  10 , Pierre Singer  4   11 , Jean-François Timsit  8   12 , Virginie Prendki #  13   14   15 , Niccolò Buetti #  8   15 ; EUROBACT-2 Study Group, the European Society of Intensive Care Medicine (ESICM), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Groups for Infections in Critically Ill Patients (ESGCIP) and Infections in the Elderly (ESGIE), and the OUTCOMEREA Network
Collaborators, Affiliations
Comparative Study

Presentation, management, and outcomes of older compared to younger adults with hospital-acquired bloodstream infections in the intensive care unit: a multicenter cohort study

Ili Margalit et al. Infection. 2024 Dec.

Erratum in

Abstract

Purpose: Older adults admitted to the intensive care unit (ICU) usually have fair baseline functional capacity, yet their age and frailty may compromise their management. We compared the characteristics and management of older (≥ 75 years) versus younger adults hospitalized in ICU with hospital-acquired bloodstream infection (HA-BSI).

Methods: Nested cohort study within the EUROBACT-2 database, a multinational prospective cohort study including adults (≥ 18 years) hospitalized in the ICU during 2019-2021. We compared older versus younger adults in terms of infection characteristics (clinical signs and symptoms, source, and microbiological data), management (imaging, source control, antimicrobial therapy), and outcomes (28-day mortality and hospital discharge).

Results: Among 2111 individuals hospitalized in 219 ICUs with HA-BSI, 563 (27%) were ≥ 75 years old. Compared to younger patients, these individuals had higher comorbidity score and lower functional capacity; presented more often with a pulmonary, urinary, or unknown HA-BSI source; and had lower heart rate, blood pressure and temperature at presentation. Pathogens and resistance rates were similar in both groups. Differences in management included mainly lower rates of effective source control achievement among aged individuals. Older adults also had significantly higher day-28 mortality (50% versus 34%, p < 0.001), and lower rates of discharge from hospital (12% versus 20%, p < 0.001) by this time.

Conclusions: Older adults with HA-BSI hospitalized in ICU have different baseline characteristics and source of infection compared to younger patients. Management of older adults differs mainly by lower probability to achieve source control. This should be targeted to improve outcomes among older ICU patients.

Keywords: Bacteremia; Elderly; ICU; Mortality; Nosocomial Infections.

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Conflict of interest statement

Declarations. Conflict of interest: Over the past three years, F.B. declares having received lecture and consulting fees from MSD, lecture fees for BioMérieux and conference invitation from Pfizer, not related to the submitted work. N.B. received a post.doc Mobility grant (2021) from the Swiss National Science Foundation (grant number: P4P4PM_194449). All other authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Study flow diagram. DNR do not resuscitate, ICUs intensive care units, y/o years old
See this image and copyright information in PMC

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