| Summary: | 碩士 === 國立臺灣大學 === 公共衛生碩士學位學程 === 104 === Background:
Healthcare-associated bloodstream infection (HABSI) is an important indicator for healthcare quality, since it may complicate clinical course and worsen outcomes. Geriatric patients are considered to have more vulnerable risk and mortality to infections compared with middle-aged patients. However, the differences in patient characteristics, HABSI outcomes and prognostic factors between geriatric and middle-aged population are scarcely reported. Our study, as a Practicum Report of Master of Public Health Program at Infection Control Center, National Taiwan university Hospital, aims to provide Taiwanese data about the characteristics, outcomes and prognostic factors of HABSI.
Material and Methods:
This is a retrospective cohort study. During the annual surveillance at National Taiwan University Hospital, we systematically reviewed the demographic characteristics, comorbidities, laboratory data and 30-day mortality after HABSI from electronic chart records between January 2014 and July 2014. We are interested in the differences in the clinical characteristics, HABSI-associated outcomes and prognostic factors between geriatric patients (≧65 years) and middle-aged patients (40-64 years). The basic characteristics and mortality of middle-aged patients and geriatric patients were compared using Chi square for categorical variables and t test for continuous variables. We set HABSI-associated 30-day mortality as outcome and use univariable logistic regression and cross table to calculate crude odds ratio. We included the factors with significant crude odds ratio in the multivariable logistic regression to find independent prognostic factors. All statistical analysis was performed using SAS 9.3 with a significance level of 0.05.
Results:
Totally 258 middle-aged patients and 228 geriatric patients were included. Geriatric patients had higher disease severity then middle-aged patients (Charlson score, 5.5 versus 4.6; p<0.001). Higher percentage of middle-aged patients had hematological malignancy (37% versus 14%, p<0.001), while most geriatric patients had chronic comorbidities, such as renal diseases (29% v.s 13%, p<0.001), diabetes mellitus (42% versus 13%, p<0.001), solid cancer (63% v.s 53%, p=0.02), congestive heart failure (16% versus 5%, p<0.001) and cerebral vascular accident (13% versus 6.6%, p<0.001). Geriatric patients also had lower albumin level than middle-aged patients (3.39 v.s 3.78, p<0.001). There were no significant differences of causative pathogens and outcomes between these two groups. High Charlson score (OR 1.30, 95% CI 1.10-1.53), methicillin-resistant Staphylococcus aureus infection (OR 13.22, 95% CI 1.25-140.19), vancomycin-resistant enterococcus species infection (OR 13.86, 95% CI 2.10-91.59) and high C-reactive protein (OR 1.08, 95% CI 1.02-1.14) are statistically significant independent risk factors. High albumin level is independent protective factor (OR 0.48, 95% CI 0.27-0.85).
Conclusion:
Geriatric patients had higher disease severity and more chronic comorbidities compared with middle-aged patients. Higher disease severity, lower serum albumin level and severe inflammation during infection were poor prognostic factors for healthcare-associated bloodstream infection related 30-day mortality. Disease severity had a special role in geriatric patients while serum albumin and inflammation during infection were more important for middle-aged patients.
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