Nosocomial infections and outcome of critically ill elderly patients after surgery.
BACKGROUND
The relation between older age and nosocomial infection and mortality in the intensive care unit (ICU) is still a controversial issue.


METHODS
The authors prospectively studied 406 patients admitted to a surgical ICU, 106 of whom were more than 75 yr old. Information concerning ICU-acquired nosocomial infections, severity of illness, therapeutic activity, and hospital outcome was collected. A Cox proportional hazard analysis was used to evaluate potential risk factors for ICU-acquired nosocomial infections, ICU, and hospital death.


RESULTS
During their ICU stay, 23 elderly patients experienced 40 nosocomial infections, 28 "young" patients (< 60 yr) experienced 54 nosocomial infections, and 52 "intermediate age" patients (60-75 yr) experienced 98 nosocomial infections. Incidence density of nosocomial infections was 4.9% patient days for elderly patients, 4.7% for young patients, and 6.0% for intermediate age patients (no significance). The frequency distribution of the various microorganisms isolated was similar between the three groups. Compared with younger patients, elderly patients had a higher Acute Physiology and Chronic Health Evaluation II score and a higher ICU and hospital mortality rate. Despite a higher level of severity of illness, elderly patients had a reduction of therapeutic activity. However, Cox proportional hazard analysis showed that age more than 75 yr was not a risk factor for ICU-acquired nosocomial infection, ICU, or hospital death.


CONCLUSIONS
In patients referred to a surgical ICU after a surgical procedure, age more than 75 yr by itself does not appear to be a significant predictor of ICU-acquired nosocomial infection or mortality rate during the ICU stay. However, it appears that patients more than 60 yr have a higher incidence of nosocomial infection in ICU.
Stéphan
F
F
Service d'Anesthésie-Réanimation Chirurgicale, H pital Tenon, Paris, France. francois.stephan@hmn.ap-hop.paris.fr
Cheffi
A
A
Bonnet
F
F
D018806:APACHE; D000328:Adult; D017677:Age Distribution; D000368:Aged; D003428:Cross Infection / Q000145:classification / Q000453:epidemiology*; D005260:Female; D005602:France / Q000453:epidemiology; D006304:Health Status; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D017678:Sex Distribution