scholarly journals Clinical Analysis of Hospital-acquired Bloodstream Infection in the Elderly

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Baojun Sun
Keyword(s):  
Risk Factors ◽  
Renal Insufficiency ◽  
Elderly Patients ◽  
Bloodstream Infection ◽  
Sofa Score ◽  
Chronic Renal Insufficiency ◽  
Bloodstream Infections ◽  
The Elderly ◽  
Independent Risk Factors ◽  
Hospital Acquired

Objective: This study was designed to get epidemiological characteristics, etiology characteristics, prognosis assessment and prognostic factors of hospital-acquired bloodstream infection (HABSI) in the elderly in Chinese PLA General Hospital and aimed at providing a reference for HABSI in the elderly on clinical diagnosis and treatment to improve the prognosis. Methods: The clinical data and pathology data of 210 cases of the elderly patients with HABSI from 2009 to 2012 in geriatric wards were retrospectively analyzed. Compare the clinical assessment effects of APACHE-II score, SAPS-II score and SOFA score to HABSI prognosis in the elderly by plotting the receiver operating characteristic curve. Use univariate and multivariate logistic regression analysis to get prognostic factors of HABSI in the elderly. Results: Univariate analysis of mortality: Day 1 apache -> 18 II score, lung infection, invasive ventilation, chronic hepatic insufficiency, chronic renal insufficiency, substantive organ malignant tumor, deep venipuncture, indwelling gastric tube indwelling ureter, complicated with shock and acquired bloodstream infections in the elderly patients with 7 days survival state association is significant. Day-1 SOFA score>7, chronic liver dysfunction, chronic renal insufficiency, concurrent shock, hemodialysis and 28-day survival status of patients with acquired bloodstream infection in elderly hospitals were significantly associated. Multivariate unconditioned logistic regression analysis related to death: Day-1APACHE-II score>18, parenchymal malignant tumors, and concurrent shock are independent risk factors for 7-day death in elderly patients with acquired bloodstream infection. Day-1 SOFA score>7, chronic renal insufficiency, and concurrent shock are independent risk factors for 28-day mortality in elderly patients with acquired bloodstream infection. Conclusion: The incidence of acquired bloodstream infections in the elderly was 1.37%. The 7-day and 28-day mortality rates were 8.10% and 22.38%, respectively. Concurrent shock is 26.7%. The 28-day mortality rate of concurrent shock patients was 48.21%. The best outcome score for the 7-day prognosis of elderly patients with acquired bloodstream infection was the Day-1APACHE-II score, followed by the Day-1 SOFA score. The best score for the 28-day prognostic assessment was the Day-1 SOFA score.

scholarly journals Clinical Analysis of Hospital-acquired Bloodstream Infection in the Elderly

2019 ◽  
Vol 1 (01) ◽  
Author(s):  
Baojun Sun
Keyword(s):  
Risk Factors ◽  
Renal Insufficiency ◽  
Elderly Patients ◽  
Bloodstream Infection ◽  
Sofa Score ◽  
Chronic Renal Insufficiency ◽  
Bloodstream Infections ◽  
The Elderly ◽  
Independent Risk Factors ◽  
Hospital Acquired

Objective: This study was designed to get epidemiological characteristics, etiology characteristics, prognosis assessment and prognostic factors of hospital-acquired bloodstream infection (HABSI) in the elderly in Chinese PLA General Hospital and aimed at providing a reference for HABSI in the elderly on clinical diagnosis and treatment to improve the prognosis. Methods: The clinical data and pathology data of 210 cases of the elderly patients with HABSI from 2009 to 2012 in geriatric wards were retrospectively analyzed. Compare the clinical assessment effects of APACHE-II score, SAPS-II score and SOFA score to HABSI prognosis in the elderly by plotting the receiver operating characteristic curve. Use univariate and multivariate logistic regression analysis to get prognostic factors of HABSI in the elderly. Results: Univariate analysis of mortality: Day 1 apache -> 18 II score, lung infection, invasive ventilation, chronic hepatic insufficiency, chronic renal insufficiency, substantive organ malignant tumor, deep venipuncture, indwelling gastric tube indwelling ureter, complicated with shock and acquired bloodstream infections in the elderly patients with 7 days survival state association is significant. Day-1 SOFA score>7, chronic liver dysfunction, chronic renal insufficiency, concurrent shock, hemodialysis and 28-day survival status of patients with acquired bloodstream infection in elderly hospitals were significantly associated. Multivariate unconditioned logistic regression analysis related to death: Day-1APACHE-II score>18, parenchymal malignant tumors, and concurrent shock are independent risk factors for 7-day death in elderly patients with acquired bloodstream infection. Day-1 SOFA score>7, chronic renal insufficiency, and concurrent shock are independent risk factors for 28-day mortality in elderly patients with acquired bloodstream infection. Conclusion: The incidence of acquired bloodstream infections in the elderly was 1.37%. The 7-day and 28-day mortality rates were 8.10% and 22.38%, respectively. Concurrent shock is 26.7%. The 28-day mortality rate of concurrent shock patients was 48.21%. The best outcome score for the 7-day prognosis of elderly patients with acquired bloodstream infection was the Day-1APACHE-II score, followed by the Day-1 SOFA score. The best score for the 28-day prognostic assessment was the Day-1 SOFA score.

Risk Factors for Central Line–Associated Bloodstream Infections in the Era of Prevention Bundles

2014 ◽  
Vol 36 (2) ◽  
pp. 214-216 ◽  
Author(s):  
Devin Callister ◽  
Pauline Limchaiyawat ◽  
Samantha J. Eells ◽  
Loren G. Miller
Keyword(s):  
Risk Factors ◽  
Bloodstream Infection ◽  
Hemodynamic Monitoring ◽  
Bloodstream Infections ◽  
Central Line ◽  
Infection Risk ◽  
Case Control ◽  
Infect Control Hosp ◽  
Infection Risk Factors ◽  
Independent Risk Factors

Little is known about central line–associated bloodstream infection risk factors in the bundle era. In our case-control investigation, we found that independent risk factors for central line–associated bloodstream infection at our center included the number of recent lab tests, catheter duration, and lack of hemodynamic monitoring as the insertion indication.Infect Control Hosp Epidemiol 2014;00(0): 1–3

scholarly journals Prevalence of chronic renal insufficiency in the Chinese population: A cross-sectional study

2020 ◽  
Author(s):  
Lingling Xu ◽  
Jin Liu ◽  
Dongling Li ◽  
Hua Yang ◽  
Kechuan Shi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Heart Rate ◽  
Blood Glucose ◽  
Renal Insufficiency ◽  
Chronic Renal Insufficiency ◽  
Central Obesity ◽  
Fasting Blood Glucose ◽  
Female Sex ◽  
Independent Risk Factors

Abstract Background: The prevalence of chronic kidney disease (CKD) is increasing worldwide, and it has become a global health issue with a high economic burden. Chronic renal insufficiency (CRI), the most severe form of CKD, is associated with increased risks of cardiovascular disease, premature mortality, and decreased quality of life. However, epidemiological information on Chinese patients with CRI is still lacking. This study aimed to investigate the prevalence and epidemiological features of CRI in China. Methods: A total of 395,541 individuals aged ≥ 18 years residing in Binhai county, China were enrolled. e estimated the prevalence of CRI adjusting for age and sex. Associations of age, sex, blood pressure, body mass index, heart rate, and fasting blood glucose and triglyceride levels with CRI were examined. Odds ratios were calculated using a binary logistic regression model. Data were obtained from the records of universal health examinations of Binhai county residents conducted from January to December 2018. Results: The overall adjusted prevalence of CRI was 1.10% (95% confidence interval [CI], 1.07%-1.13%) in this Chinese adult population. The prevalence was 0.86% among men (95% CI, 0.82%-0.90%) and 1.34% among women (95% CI, 1.29%-1.39%). Female sex, age (per 10-year increase), central obesity, triglyceride levels (per 118-mg/dl increase), systolic blood pressure (per 10-mmHg increase), heart rate (per 10-beats/min increase) and fasting blood glucose ≥ 100 mg/dl were found to be independent risk factors for CRI. Conclusions: The overall prevalence of CRI in Chinese adults was 1.10%. Age, female sex, central obesity, higher triglycerides, SBP, heart rate and elevated fasting glucose levels were all independent risk factors associated with decreased eGFR. Health policies to prevent CRI are urgent among this population.

scholarly journals Clinical analysis of bloodstream infection of Escherichia coli in patients with pancreatic cancer

2019 ◽  
Author(s):  
Changsen Bai ◽  
Xiuse Zhang ◽  
Dong Yang ◽  
Ding Li ◽  
Wenfang Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Bloodstream Infection ◽  
Multivariate Logistic Regression Analysis ◽  
Bloodstream Infections ◽  
Clinical Analysis ◽  
Infection Group ◽  
Independent Risk Factors

Abstract Background To study the common pathogens and cancer types of bloodstream infection (BSI) in cancer patients, find the risk factors and conduct clinical analysis.Methods The clinical data of 2302 patients with BSI in Tianjin Medical University Cancer Institute and Hospital (TMUCIH) from January 2011 to December 2018 were retrospectively analyzed. 31 pancreatic cancer patients complicated with Escherichia coli BSI and 93 pancreatic cancer patients without BSI at the same period with similar sex and age were divided into infection group and non-infection group.Results 645 strains (28%) of Escherichia coli were the main pathogens causing BSI in patients with cancer. 57 cases (8.8%) of cancer patients with Escherichia coli BSI were from pancreatic oncology department, among which 31 cases were diagnosed as pancreatic cancer by pathology. Multivariate logistic regression analysis showed that hospitalization days≥7, chemotherapy and neutrophil>5.5×10 9 /L were independent risk factors for pancreatic cancer patients complicated with BSI (P < 0.05). Quantitative analysis of serum-related indicators in infection patients and non-infection patients showed significant differences between albumin, prealbumin and neutrophils in infection and non-infection group. The ratio of Escherichia coli producing extended-spectrum ß-lactamase is 49.3 and 48.1 in pancreatic cancer and non-pancreatic patients. Escherichia coli resistant to carbapenems is rare, they were highly sensitive to Cephamycin and Piperacillin/tazobactam.Conclusions Escherichia coli, the main pathogen causing BSI of cancer patients, is more common in pancreatic cancer patients. The independent risk factors include hospitalization days≥7 days, chemotherapy and neutrophils larger than 5.5×10 9 /L. Quantitative indicators of neutrophil counts, albumin and prealbumin contribute to the early diagnosis of bloodstream infections. Early use of medication, while timely adjustment based on clinical drug sensitivity results will help reduce patient morbidity and mortality.

scholarly journals Risk Factors Contributing to Higher Mortality Rates in Elderly Patients with Acute Traumatic Subdural Hematoma Sustained in a Fall: A Cross-Sectional Analysis Using Registered Trauma Data

2018 ◽  
Vol 15 (11) ◽  
pp. 2426 ◽  
Author(s):  
Ching-Hua Hsieh ◽  
Cheng-Shyuan Rau ◽  
Shao-Chun Wu ◽  
Hang-Tsung Liu ◽  
Chun-Ying Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Elderly Patients ◽  
Subdural Hematoma ◽  
Odds Ratio ◽  
The Elderly ◽  
Mortality Rates ◽  
Acute Subdural Hematoma ◽  
Hematoma Volume ◽  
Independent Risk Factors

Background: We aimed to explore the risk factors that contribute to the mortality of elderly trauma patients with acute subdural hematoma (SDH) resulting from a fall. Mortality rates of the elderly were compared to those of young adults. Methods: A total of 444 patients with acute traumatic subdural hematoma resulting from a fall, admitted to a level I trauma center from 1 January 2009 to 31 December 2016 were enrolled in this study. Patients were categorized into two groups: elderly patients (n = 279) and young adults (n = 165). The primary outcome of this study was patient mortality in hospital. The adjusted odds ratio (AOR) with 95% confidence interval (CI) for mortality was calculated according to gender and pre-existing comorbidities. Univariate and multivariate logistic regression analyses were performed to identify factors related to mortality in the elderly. Results: The odds ratio for mortality caused by falls in the elderly patients was four-fold higher than in the young adults, after adjusting for gender and pre-existing comorbidities. In addition, the presence of pre-existing coronary artery disease (OR 3.2, 95% CI 1.09–9.69, p = 0.035), end-stage renal disease (OR 4.6, 95% CI 1.48–14.13, p = 0.008), hematoma volume (OR 1.2, 95% CI 1.11–1.36, p < 0.001), injury severity score (OR 1.3, 95% CI 1.23–1.46, p < 0.001), and coagulopathy (OR 4.0, 95% CI 1.47–11.05, p = 0.007) were significant independent risk factors for mortality in patients with acute traumatic SDH resulting from a fall. Conclusions: In this study, we identified that pre-existing CAD, ESRD, hematoma volume, ISS, and coagulopathy were significant independent risk factors for mortality in patients with acute traumatic SDH. These results suggest that death following acute SDH is influenced both by the extent of neurological damage and the overall health of the patient at the time of injury.

scholarly journals Hospital-acquired pneumonia due to Achromobacter xylosoxidans in the elderly: A single-center retrospective study in Beijing

2017 ◽  
Vol 11 (01) ◽  
pp. 10-18 ◽  
Author(s):  
Chao Liu ◽  
Jun Guo ◽  
Weifeng Yan ◽  
Yi Jin ◽  
Fei Pan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Clinical Manifestations ◽  
The Elderly ◽  
Achromobacter Xylosoxidans ◽  
Apache Ii Score ◽  
Chronic Obstructive ◽  
Indwelling Catheter ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Introduction: Achromobacter xylosoxidans has been reported in several countries; however, hospital-acquired pneumonia (HAP) due to this organism in elderly patients in China remains rare. Methodology: HAP due to Achromobacter xylosoxidans identified at the General Hospital of the People's Liberation Army in Beijing from January 2008 to October 2011 was studied. Detailed clinical manifestations were collected. To study the clinical risk factors for the imipenem-resistant strain, patients were divided into two groups: imipenem-resistant (21 cases) and imipenem-nonresistant (20 cases). Univariate and multivariate logistic regression were used. Results: All patients were > 75 years of age, and 92.7% (38/41) were male. Nine patients died 30 days after infection. The mean acute physiology and chronic health evaluation (APACHE) II score and sequential organ failure assessment (SOFA) were 23.66 ± 7.71 and 6.93 ± 2.47, respectively. Almost all strains were resistant to aminoglycosides. However, the strains showed significant sensitivity to minocycline (MIN), piperacillin-tazobactam (PTZ), and cefoperazone-sulbactam (SCF). Compared with the imipenem-nonresistant group, more patients with imipenem-resistant infection had the following characteristics: use of an intubation, use of a proton-pump inhibitor (PPI), chronic obstructive pulmonary disease (COPD), and coronary artery disease (CHD). Among the four risk factors, COPD and CHD remained independent risk factors in the multivariate analysis. Conclusions: HAP due to Achromobacter xylosoxidans occurred in severely ill elderly patients with a long-term indwelling catheter and many underlying diseases. Effective treatment of imipenem-resistant organisms is challenging. SCF, PTZ, and MIN may be useful for imipenem-resistant Achromobacter xylosoxidans.

scholarly journals Analysis of Effectiveness, Safety, and Bleeding Related to Rivaroxaban in Elderly Patients

2020 ◽  
Vol 26 ◽  
pp. 107602962092592
Author(s):  
Huimin Hou ◽  
Ang Li ◽  
Liping Zhang ◽  
Xiujiao Qin ◽  
Yanfang Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Multivariate Logistic Regression Analysis ◽  
The Elderly ◽  
Multivariate Logistic Regression ◽  
Bleeding Events ◽  
Old Patients ◽  
Daily Dose ◽  
Independent Risk Factors ◽  
Different Doses

This study explored the efficacy and safety of rivaroxaban in elderly patients, at different doses and age of patients, and analyzed risk factors of bleeding. A retrospective analysis was conducted of 299 patients aged 60 years or older who were admitted to the First Hospital of Jilin University between January 2016 and August 2018. It was found that the rate of bleeding events (but not embolism) significantly increased as the dose of oral rivaroxaban increased ( P < .001), and with age, especially in patients aged ≥80 years ( P = .001, both). The multivariate logistic regression analysis indicated that age (odds ratio [OR]: 2.963, 95% CI: 1.627-5.396) and the daily dose of rivaroxaban (OR: 2.325, 95% CI: 1.483-3.645) were independent risk factors for bleeding. The study determined that rivaroxaban anticoagulant therapy is effective in the elderly patients, but the risk of bleeding increases with age, and is a concern especially in the most old patients. The recommended daily dose of rivaroxaban is effective, but a lower dose is safer for the elderly patients.

scholarly journals Early warning of bloodstream infection in elderly patients with circulating microparticles

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tingting Liu ◽  
Jiang Wang ◽  
Yaping Yuan ◽  
Jionghe Wu ◽  
Chao Wang ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Bloodstream Infection ◽  
Early Warning ◽  
Predictive Value ◽  
Treatment Plan ◽  
Area Under The Curve ◽  
Bloodstream Infections ◽  
The Elderly ◽  
Early Warning Model ◽  
Warning Model

Abstract Background The difficulty of early diagnosis of bloodstream infection in the elderly patients leads to high mortality. Therefore, it is essential to determine some new methods of early warning of bloodstream infection in the elderly patients for timely adjustment of treatment and improvement of prognosis. Methods Patients aged over 65 years with suspected bloodstream infections were included and divided into bloodstream infection (BSI) and non-bloodstream infection (non-BSI) groups based on blood culture results. The morphology of microparticles (MPs) was observed by using transmission electron microscopy, and the number of MPs was dynamically monitored by flow cytometry. Results A total of 140 patients were included in the study: 54 in the BSI group and 86 in the non-BSI group. Total MPs (T-MPs) ≥ 6000 events/µL (OR, 7.693; 95% CI 2.944–20.103, P < 0.0001), neutrophil-derived MPs (NMPs) ≥ 500 events/µL (OR, 12.049; 95% CI 3.574–40.623, P < 0.0001), and monocyte counts ≤ 0.4 × 109/L (OR, 3.637; 95% CI 1.415–9.348, P = 0.007) within 6 h of fever were independently associated with bloodstream infection in the elderly patients. We also developed an early warning model for bloodstream infection in the elderly patients with an area under the curve of 0.884 (95% CI 0.826–0.942, P < 0.0001), sensitivity of 86.8%, specificity of 76.5%, positive predictive value of 70.8%, and negative predictive value of 89.8%. Conclusion The early warning model of bloodstream infection based on circulating T-MPs, NMPs, and monocyte counts within 6 h of fever in the elderly patients was helpful in early detection of bloodstream infection and therefore promptly adjustment of treatment plan.

scholarly journals HsCRP Variation is the Main Risk Factor for Clinical Outcome in COVID-19 Hospitalized Young and Middle-Aged Patients

2020 ◽  
Author(s):  
Zhelong Liu ◽  
Danning Wu ◽  
Xia Han ◽  
Wangyan Jiang ◽  
Lin Qiu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Elderly Patients ◽  
Clinical Characteristics ◽  
The Elderly ◽  
Middle Aged ◽  
Aged Patients ◽  
Icu Admission ◽  
Discharged Patients ◽  
Independent Risk Factors

Abstract Background: The clinical characteristics and risk factors of clinical outcomes of COVID-19 in elderly and non-elderly patients show great difference. We are the first to explore the relationship between hsCRP variation and intensive care unit (ICU) admission in young and middle-aged COVID-19 patients compared with elderly patients.Methods: We included 273 hospitalized patients with confirmed COVID-19 from Tongji Hospital, Wuhan, China from Feb 10, 2020 to Mar 8, 2020. Clinical characteristics and risk factors of outcomes were compared between young and middle-aged patients with elderly patients.Results: Among young and middle-aged patients, hsCRP variation in those admitted to ICU was significantly higher than that in discharged patients. Among patients admitted to ICU, hsCRP variation showed significantly difference between young and middle-aged patients and elderly patients (median, 67.9 vs -10.2, P < 0.01). The hsCRP variation was an independent risk factor for ICU admission in young and middle-aged patients (OR = 1.068) and ROC curve revealed hsCRP variation significant for the prediction of ICU admission (AUC = 0.925) with 92.9% sensitivity and 95.5% specificity. Conclusion: HsCRP variation is the major independent risk factors for ICU admission in young and middle-aged COVID-19 inpatients, but not in the elderly patients.

scholarly journals A New Preoperative Risk Score for Predicting Postoperative Complications in Elderly Patients Undergoing Hepatectomy

2021 ◽  
Author(s):  
Koichi Tomita ◽  
Itsuki Koganezawa ◽  
Masashi Nakagawa ◽  
Shigeto Ochiai ◽  
Takahiro Gunji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Skeletal Muscle ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Risk Score ◽  
Surgical Procedure ◽  
Evaluation Method ◽  
Preoperative Risk ◽  
Preoperative Serum ◽  
Independent Risk Factors

Abstract Background Postoperative complications are not rare in the elderly population after hepatectomy. However, predicting postoperative risk in elderly patients undergoing hepatectomy is not easy. We aimed to develop a new preoperative evaluation method to predict postoperative complications in patients above 65 years of age using biological impedance analysis (BIA). Methods Clinical data of 59 consecutive patients (aged 65 years or older) who underwent hepatectomy at our institution between 2017 and 2020 were retrospectively analyzed. Risk factors for postoperative complications (Clavien-Dindo ≥ III) were evaluated using multivariate regression analysis. Additionally, a new preoperative risk score was developed for predicting postoperative complications. Results Fifteen patients (25.4%) had postoperative complications, with biliary fistula being the most common complication. Abnormal skeletal muscle mass index from BIA and type of surgical procedure were found to be independent risk factors in the multivariate analysis. These two variables and preoperative serum albumin levels were used for developing the risk score. The postoperative complication rate was 0.0% with a risk score of ≤ 1 and 57.1% with a risk score of ≥ 4. The area under the receiver operating characteristic curve of the risk score was 0.810 (p = 0.001), which was better than that of other known surgical risk indexes. Conclusion Decreased skeletal muscle and the type of surgical procedure for hepatectomy were independent risk factors for postoperative complications after elective hepatectomy in elderly patients. The new preoperative risk score is simple, easy to perform, and will help in the detection of high-risk elderly patients undergoing elective hepatectomy.

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