Critically Ill Elderly Adults With Infection
Critically Ill Elderly Adults With Infection
Objectives To determine the effect of age on patterns of infection and on outcomes in individuals with infection.
Design Analysis of data from an international, observational, point-prevalence study: Extended Prevalence of Infection in Intensive Care (EPIC II).
Setting Intensive care units (ICUs; N = 1,265) in 75 countries.
Participants All adults present in a participating ICU on May 8, 2007. Individuals with an infection were included and classified according to age (18–44, 45–64, 65–74, 75–84, ≥85).
Measurements Demographic, physiological, bacteriological, and therapeutic data were collected on the day of the study. Outcome data were collected until hospital discharge or for 60 days.
Results Of the 13,796 adults enrolled in EPIC II, 7,087 (51.4%) had an infection. Of these, 330 (4.7%) were aged 85 and older, 1,405 (19.8%) were 75 to 84, 1,713 (24.2%) were 65 to 74, 2,358 (33.3%) were 45 to 64, and 1,281 (18.1%) were 18 to 44. Severity of illness did not differ between groups. Those aged 85 and older had fewer bloodstream infections than those younger than 75, fewer central nervous system infections than those who were younger than 65, and more abdominal infections than those who were younger than 45. A microbiological diagnosis was established less frequently in participants aged 85 and older than in younger participants. Gram-negative microorganisms were more frequently isolated in those aged 85 and older than in other groups. ICU and hospital mortality were significantly higher in participants aged 85 and older than in those who were younger than 65.
Conclusion A large proportion of individuals in the ICU with infection are aged 65 and older. Patterns of infection, including site and type of microorganism, vary according to age. Being aged 85 and older was an independent risk factor for mortality in individuals in the ICU with infection.
The elderly population is increasing in terms of absolute numbers and proportion of the overall population. In intensive care units (ICUs), the reported proportion of elderly adults varies from 12% to 58%, and elderly adults account for almost 60% of all ICU days. The aging process leads to variable changes in physiological and morphological functions of the human body, making elderly adults potentially more vulnerable to infections. Rates of nosocomial infection are particularly high in the ICU, where the most-severely ill individuals are treated, and the use of invasive devices and immunosuppressive therapies is common. Data on infection in elderly adults in the ICU are limited and usually describe specific subpopulations (e.g., individuals with severe community-acquired pneumonia or nosocomial bacteremia or individuals after surgery) or are reports from small single-center cohorts, which cannot provide an accurate general view of the characteristics of the infected elderly critically ill population.
The hypothesis of the present study was that the general population of elderly adults in the ICU with infection (nosocomial and community acquired) differs from younger critically ill individuals and that differences exist within the elderly group. The large database of the Extended Prevalence of Infection in Intensive Care (EPIC II) study was therefore used to identify potential differences between elderly and younger adults in the ICU with infection and between elderly subgroups, especially with regard to patterns of infection and outcome, and to examine whether older age was an independent risk factor for mortality.
Abstract and Introduction
Abstract
Objectives To determine the effect of age on patterns of infection and on outcomes in individuals with infection.
Design Analysis of data from an international, observational, point-prevalence study: Extended Prevalence of Infection in Intensive Care (EPIC II).
Setting Intensive care units (ICUs; N = 1,265) in 75 countries.
Participants All adults present in a participating ICU on May 8, 2007. Individuals with an infection were included and classified according to age (18–44, 45–64, 65–74, 75–84, ≥85).
Measurements Demographic, physiological, bacteriological, and therapeutic data were collected on the day of the study. Outcome data were collected until hospital discharge or for 60 days.
Results Of the 13,796 adults enrolled in EPIC II, 7,087 (51.4%) had an infection. Of these, 330 (4.7%) were aged 85 and older, 1,405 (19.8%) were 75 to 84, 1,713 (24.2%) were 65 to 74, 2,358 (33.3%) were 45 to 64, and 1,281 (18.1%) were 18 to 44. Severity of illness did not differ between groups. Those aged 85 and older had fewer bloodstream infections than those younger than 75, fewer central nervous system infections than those who were younger than 65, and more abdominal infections than those who were younger than 45. A microbiological diagnosis was established less frequently in participants aged 85 and older than in younger participants. Gram-negative microorganisms were more frequently isolated in those aged 85 and older than in other groups. ICU and hospital mortality were significantly higher in participants aged 85 and older than in those who were younger than 65.
Conclusion A large proportion of individuals in the ICU with infection are aged 65 and older. Patterns of infection, including site and type of microorganism, vary according to age. Being aged 85 and older was an independent risk factor for mortality in individuals in the ICU with infection.
Introduction
The elderly population is increasing in terms of absolute numbers and proportion of the overall population. In intensive care units (ICUs), the reported proportion of elderly adults varies from 12% to 58%, and elderly adults account for almost 60% of all ICU days. The aging process leads to variable changes in physiological and morphological functions of the human body, making elderly adults potentially more vulnerable to infections. Rates of nosocomial infection are particularly high in the ICU, where the most-severely ill individuals are treated, and the use of invasive devices and immunosuppressive therapies is common. Data on infection in elderly adults in the ICU are limited and usually describe specific subpopulations (e.g., individuals with severe community-acquired pneumonia or nosocomial bacteremia or individuals after surgery) or are reports from small single-center cohorts, which cannot provide an accurate general view of the characteristics of the infected elderly critically ill population.
The hypothesis of the present study was that the general population of elderly adults in the ICU with infection (nosocomial and community acquired) differs from younger critically ill individuals and that differences exist within the elderly group. The large database of the Extended Prevalence of Infection in Intensive Care (EPIC II) study was therefore used to identify potential differences between elderly and younger adults in the ICU with infection and between elderly subgroups, especially with regard to patterns of infection and outcome, and to examine whether older age was an independent risk factor for mortality.
