Impact of Comorbidities on Hospital-Acquired Infections in a Geriatric Rehabilitation Unit: Prospective Study of 252 Patients |
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| Authors: | Marie Laurent Phuong Nhi Bories Aurelie Le Thuaut Evelyne Liuu Katia Ledudal Sylvie Bastuji-Garin Elena Paillaud |
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| Institution: | 1. Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Henri-Mondor, Département de médecine interne et gériatrie, Creteil, France;2. Université Paris Est, Faculté de Médecine, Créteil, France;3. Assistance Publique-Hôpitaux de Paris (APHP), hôpital Cochin, Service de Biochimie inter-hospitalier Cochin-Hôtel-Dieu, Paris, France;4. Assistance Publique-Hôpitaux de Paris (APHP), hôpital Henri-Mondor, Unité de Recherche Clinique (URC), Creteil, France;5. Assistance Publique-Hôpitaux de Paris (APHP), hôpital Henri-Mondor, INSERM, Centre d''Investigation Clinique 006, Creteil, France;6. Assistance Publique-Hôpitaux de Paris (APHP), hôpital Henri-Mondor, Pôle Recherche Clinique et Santé Publique, Creteil, France;1. Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Saint-Joseph University, Damascus road, BP 11-5076, Beirut, Lebanon;2. Pharmacy department, Hôtel-Dieu de France University Hospital, Beirut, Lebanon;3. Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon;1. University of Alabama at Birmingham;2. Children''s of Alabama, Birmingham;1. Physical Medicine and Rehabilitation Department, European Interbalkan Medical Center, Thessaloniki, Greece;2. Department of Geriatric Medicine, Xuanwu Hospital of Capital Medical University, Beijing, China;3. Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland;4. Stroke Rehabilitation Unit, Department of Geriatrics Medicine and Department of Rehabilitation Medicine, 1st Medical Faculty of Charles University and General Teaching Hospital, Prague, Czech Republic;5. Geriatrics Department, Hospital Ramon y Cajal, Madrid, Spain;1. Department of Infectious Diseases, Ramón y Cajal Hospital, Madrid, Spain;2. Department of Pharmacy, Ramón y Cajal Hospital, Madrid, Spain;1. Department of Medicine, University of Wisconsin Medical School, Madison, WI;2. University of Wisconsin Hospitals and Clinics, Infection Control, University of Wisconsin, Madison, WI;3. William S. Middleton Memorial Veterans Affairs Hospital, Madison, WI;1. Department of Respiratory, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan 528315, China;2. Department of Respiratory, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China |
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| Abstract: | ObjectivesHospital-acquired infections (HAIs) remain a major source of morbidity and mortality in long-term care units, despite advances in antimicrobial therapy and preventive measures. Our aim was to investigate risk factors for HAIs, especially in the elderly, and to describe the relationship between comorbidities (number, severity, and specific diseases) and HAIs using a comprehensive inventory of comorbidities.DesignProspective cohort studySettingGeriatric rehabilitation unit in a university hospital in the Paris metropolitan area.ParticipantsParticipants were 252 consecutive patients aged 75 years or older (mean age, 85 ± 6.2 years) and admitted between 2006 and 2008.MeasurementsSurveillance of HAI was conducted. A complete inventory of comorbidities was done using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Potential risk factors were evaluated in 2 risk models, one with HAI acquisition, CIRS-G, activities of daily living score less than 10, and at least 1 invasive procedure (yes/no) and the other with HAI acquisition and specific invasive procedures and diseases.ResultsOf the 252 patients, 97 experienced HAIs, for an incidence of 5.6 infections per 1000 bed-days. The most common HAI sites were the respiratory tract (48%; 65/136) and urinary tract (37%; 51/136). The CIRS-G global score and comorbidity index were higher in patients with than without HAIs. Among HAI categories, respiratory and urogenital diseases were more prevalent in the group with HAIs. In the model combining CIRS-G, activities of daily living score less than 10, and at least 1 invasive procedure, independent risk factors for HAI were CIRS-G index (odds ratio OR], 1.55; 95% confidence interval 95% CI], 1.13–2.11; P = .005) and invasive procedures (OR, 5.18; 95% CI, 2.77–9.71; P < .001). In the model including specific procedures and diseases, independent risk factors for HAI were intravenous catheter (OR, 7.39; 95% CI, 2.94–18.56; P < .001), urinary catheter (OR, 3.33; 95% CI, 1.40–7.88; P = .006), gastrointestinal endoscopy (OR, 3.69; 95% CI, 1.12–12.16; P = .03), pressure sores (OR, 2.52; 95% CI, 1.04–6.10; P = .03), and swallowing impairment (OR, 3.37; 95% CI, 1.16–9.74; P = .02).ConclusionsThis study identified several important risk factors for HAIs. There is a need for HAI prevention via the implementation of infection-control programs, including surveillance, in rehabilitation units. |
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