title: Impact of functional status on the onset of nosocomial infections in an acute care for elders unit.
abstract: OBJECTIVE
  To assess the role of functional status as a risk factor for nosocomial infections in the elderly.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Acute care for elders units of university hospital of Grenoble.
  
  
  METHODS
  All patients over 75 years old consecutively hospitalized between January and April 2007.
  
  
  METHODS
  The main judgement criteria was the rate of nosocomial infection during the hospital stay, defined according to the French technical comity against nosocomial infections. Other data included functional status at baseline and admission (Katz' ADL), usual risk factors for nosocomial infections, demographic and geriatric assessment data.
  
  
  RESULTS
  The study included 223 patients. The mean age was 86.7±6.5 years. A nosocomial infection was diagnosed for 17.0% of the patients. In univariate analysis, the number of medicines, pressure sore, pneumonia diagnosis, illness severity, indwelling bladder catheter, IADL at baseline, and all disability parameters (ADL at baseline, ADL at admission, recent functional decline) were significantly associated with nosocomial infection (p<0.05). In multivariate analysis considering functional status at admission, indwelling bladder catheter (OR=4.43), severe disability at admission (OR=4.42) and illness severity (OR=2.68) were independently associated with nosocomial infection (p<0.05). In a second analysis considering functional status at baseline, only disability at baseline was independently associated with the onset of a nosocomial infection (OR=2.21).
  
  
  CONCLUSIONS
  Our results suggest a significant impact of functional impairment on the incidence of nosocomial infections in hospitalized elderly population. Disability is a higher risk factor for nosocomial infections than the usual and well-known other parameters. Larger prospective studies are needed to examine the power of this relationship.
authors.affiliation: Sylvie Mazière, Clinique de médecine gériatrique CHU A. Michallon, 38043 Grenoble cedex 09. Tel : (+33)4 76 76 54 21, SMaziere@chu-grenoble.fr.
authors.forename: S
authors.initials: S
authors.lastname: Mazière
authors.forename: P
authors.initials: P
authors.lastname: Couturier
authors.forename: G
authors.initials: G
authors.lastname: Gavazzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D015577:Geriatric Assessment / Q000379:methods* / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011014:Pneumonia / Q000453:epidemiology; D003668:Pressure Ulcer / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D001743:Urinary Bladder