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Predictors of Nosocomial Bloodstream Infections in Older Adults

Authors

  • Keith S. Kaye MD, MPH,

    1. From the *Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan; Department of Medicine and Center for the Study of Aging and Human Development, Duke Infection Control Outreach Network and §Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina; and Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina.
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  • Dror Marchaim MD,

    1. From the *Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan; Department of Medicine and Center for the Study of Aging and Human Development, Duke Infection Control Outreach Network and §Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina; and Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina.
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  • Ting-Yi Chen MD, MPH,

    1. From the *Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan; Department of Medicine and Center for the Study of Aging and Human Development, Duke Infection Control Outreach Network and §Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina; and Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina.
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  • Teena Chopra MD,

    1. From the *Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan; Department of Medicine and Center for the Study of Aging and Human Development, Duke Infection Control Outreach Network and §Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina; and Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina.
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  • Deverick J. Anderson MD, MPH,

    1. From the *Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan; Department of Medicine and Center for the Study of Aging and Human Development, Duke Infection Control Outreach Network and §Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina; and Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina.
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  • Yong Choi CIC,

    1. From the *Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan; Department of Medicine and Center for the Study of Aging and Human Development, Duke Infection Control Outreach Network and §Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina; and Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina.
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  • Richard Sloane MPH,

    1. From the *Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan; Department of Medicine and Center for the Study of Aging and Human Development, Duke Infection Control Outreach Network and §Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina; and Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina.
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  • Kenneth E. Schmader MD

    1. From the *Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan; Department of Medicine and Center for the Study of Aging and Human Development, Duke Infection Control Outreach Network and §Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina; and Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina.
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Address correspondence to Dror Marchaim, Division of Infectious Diseases, 5 Hudson, Harper University Hospital, 3990 John R. Street, Detroit, MI 48201. E-mail: drormc@hotmail.com

Abstract

OBJECTIVES: To identify predictors and construct a prediction model for nosocomial bloodstream infection (BSI) in older adults.

DESIGN: Retrospective case–control study.

SETTING: Hospitals belonging to the Duke Infection Control Outreach Network.

PARTICIPANTS: Patients age 65 and older with a nosocomial BSI and matched uninfected controls.

MEASUREMENT: Multiple variables were captured and compared between groups. Independent predictors were identified using conditional logistic regression. A prediction model and score was constructed.

RESULTS: Eight hundred thirty cases were compared with 830 controls. Eighty-one percent of nosocomial BSIs were catheter related (CRBSI). Methicillin-resistant Staphylococcus aureus (MRSA) was the most common pathogen isolated (23%). Independent predictors of nosocomial BSI in older adults were male sex, obesity, low McCabe score on admission, presence of a central line at admission, gastrostomy at admission, recent surgery, and urinary incontinence. A prediction model score greater than 11 (total possible score 23) was predictive of infection.

CONCLUSION: MRSA is a common cause of CRBSI in older adults. Male sex, obesity, the presence of a central line, a gastrostomy tube, and urinary incontinence at the time of admission were independent predictors of BSI in hospitalized older adults. The prediction model constructed in this study should be validated prospectively in a different cohort.

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