Clinical Analysis Of Hospital-acquired Bloodstream Infection In The Elderly

Objective: This study was designed to get epidemiological characteristics, etiologycharacteristics, prognosis assessment and prognostic factors of hospital-acquiredbloodstream infection(HABSI) in the elderly in Chinese PLA General Hospital andaimed at providing a reference for HABSI in the elderly on clinical diagnosis andtreatment to improve the prognosis.Methods：The clinical data and pathology data of210cases of the elderly patients withHABSI from2009to2012in geriatric wards were retrospectively analyzed. Comparethe clinical assessment effects of APACHE-II score, SAPS-II score and SOFA score toHABSI prognosis in the elderly by plotting the receiver operating characteristic curve.Use univariate and multivariate logistic regression analysis to get prognostic factors ofHABSI in the elderly.Results:1. The elderly patients with HABSI were with mean age of87.1±6.7years,26.7%complicated by shock. The incidence of HABSI in the elderly was1.37%and7-day and28-day mortality were8.10%,22.38%respectively.28-day mortality ofpatients complicated by shock was48.21%.2. Gram-positive bacteria, Gram-negativebacteria, fungi took accounts for46.78%,36.48%,16.74%respectively. The mostcommon pathogens were coagulase-negative staphylococci, Candida, Enterococcus,Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa.3. The mostcommon pathway of HABSI were travenous catheter, biliary tract and urinary.4. Thedetection rates of Methicillin-resistant coagulase-negative staphylococci andMethicillin-resistant Staphylococcus aureus were90.91%,55.56%respectively. ESBLspositive rates of Escherichia coli and Klebsiella pneumoniae were74.19%,27.78%respectively. The imipenem-resistance rate of Pseudomonas aeruginosa was46.16%.5.APACHE-II score and SOFA score in24hours before infection(Day-1) had the best assessment effect for the prognosis of HABSI in the elderly within7days, andDay-1SOFA score was the best assessment scoce within28days.6.The univariateanalysis of the mortality-associated factors for HABSI in the elderly indicated thatDay-1APACHE-II score＞18, pulmonary infection, invasive ventilation, chronic liverfailure, chronic renal failure, solid organ malignancy, deep vein catheter, Indwellingstomach tube, Indwelling Urinary tube, complicated by shock were significantlyassociated with7days survival status, and Day-1SOFA score＞7, chronic liver functionfailure, chronic renal failure, complicated by shock, blood dialysis were significantlyassociated with28days survival status. The multivariate logistic regression analysis ofthe mortality-associated factors for HABSI in the elderly indicated thatDay-1APACHE-II score＞18, solid organ malignancies, complicated by shock wereindependent risk factors within7days, and Day-1SOFA score＞7, chronic renal failure,and complicated by shock were independent risk factors within28days.Conclusions:1. The incidence of HABSI in the elderly was1.37%and7-day and28-day mortality rate were8.10%,22.38%respectively.26.7%of the patients werecomplicated by shock and28-day mortality of those patients was48.21%.2. The mostcommon pathway of HABSI were travenous catheter, biliary tract and urinary.3.Gram-positive bacteria, Gram-negative bacteria, fungi took accounts for46.78%,36.48%,16.74%respectively. The most common pathogens were coagulase-negativestaphylococci, Candida, Enteroc-occus, Escherichia coli, Klebsiella pneumoniae,Pseudomonas aeruginosa.4. Day-1A PACHE-II score and Day-1SOFA score had thebest assessment effect for the prognosis of HABSI in the elderly within7days, andDay-1SOFA score was the best assessment scoce within28days.5. Day-1APACHE-IIscore＞18, solid organ malignancies, complicated by shock were mortality-associatedfactors within7days of HABSI in the elderly, and Day-1SOFA score＞7, chronic renalfailure, and complicated by shock were mortality-associated risk factors within28days.