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

• Published in: Infection 2024-06, Vol.52 (6), p.2435-2443
• Main Authors: Margalit, Ili, Yahav, Dafna, Hoffman, Tomer, Tabah, Alexis, Ruckly, Stéphane, Barbier, François, Singer, Pierre, Timsit, Jean-François, Prendki, Virginie, Buetti, Niccolò
• Format: Article
• Language: English
• Subjects: Adult; Adults; Age Factors; Aged; Aged, 80 and over; Bacteremia - drug therapy; Bacteremia - epidemiology; Bacteremia - microbiology; Bacteremia - mortality; Blood pressure; Cohort analysis; Cohort Studies; Comorbidity; Cross Infection - drug therapy; Cross Infection - epidemiology; Cross Infection - microbiology; Cross Infection - mortality; Family Medicine; Female; General Practice; Heart rate; Hospitalization; Hospitals; Humans; Infections; Infectious Diseases; Intensive care; Intensive Care Units - statistics & numerical data; Internal Medicine; Life Sciences; Male; Management; Medicine; Medicine & Public Health; Middle Aged; Mortality; Older people; Patients; Prospective Studies; Sepsis - epidemiology; Sepsis - microbiology; Sepsis - mortality; Signs and symptoms; Treatment Outcome
• ISSN: 0300-8126; 1439-0973; 1439-0973
• DOI: 10.1007/s15010-024-02304-y

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