Critically Ill Elderly Adults with Infection: Analysis of the Extended Prevalence of Infection in Intensive Care Study

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 61; no. 12; pp. 2065 - 2071
• Main Authors: Dimopoulos, George, Koulenti, Despoina, Blot, Stijn, Sakr, Yasser, Anzueto, Antonio, Spies, Claudia, Violán, Jordi Solé, Kett, Daniel, Armaganidis, Apostolos, Martin, Claude, Vincent, Jean Louis
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Blackwell Publishing Ltd 01-12-2013; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Age; Aged; Aged, 80 and over; APACHE; Biological and medical sciences; Comorbidity; Critical Illness; critically ill; Cross Infection - epidemiology; Female; General aspects; Humans; Infections; Intensive care; Intensive Care Units; Male; Medical sciences; Middle Aged; Miscellaneous; Mortality; Older people; Prevalence; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Human; Infection; Gerontology; Intensive care; Prevalence; Critically ill; infections; Elderly; Age; Public health; Geriatrics
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.12544

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.