Analysis of risk factors for short-term death in elderly patients with emergency Gram-negative bacteria bloodstream infection
Zhao Minjie
Tian Zhaoxing
Fu Yan
Wang Cong
Cui Beichen
Abstract：Objective To discuss the risk factors of short-term death in elderly patients in emergency department with Gram-negative bloodstream infection.Methods Totally 227 patients over 65 years old with Gram-negative bloodstream infections,admitted to the Department of Emergency,Beijing Jishuitan Hospital,Capital Medical University from January 1,2015 to December 31,2019,were selected retrospectively.Based on whether they survived after 90 d of treatment,the patients were divided into death group(41 cases)and survival group(186 cases).The independent risk factors affecting the survival were studied by Cox regression model.Results The most common infection bacteria were Escherichia coli[140 cases(61.7％)]and Klebsiella pneumoniae[39 cases(17.2％)].As for the sites of infections,the most common were urinary system infections[93 cases(41.0％)]and pulmonary infections[51 cases(22.5％)].The proportions of solid tumors,cerebrovascular disease,acute renal failure,acute liver failure,septic shock,indwelling central venous catheter,indwelling urinary catheter and invasive operation in the survival group were lower than those in the death group,while the proportion of rational use of antimicrobial drugs in the early stage was higher than that in the death group(all P＜0.05).The survival group's length of hospital stay,heart rate,respiration,D-dimer quantification,blood urea nitrogen,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,and Charleson comorbidity index score were shorter than/lower than those in the death group,while the mean arterial pressure,platelet count,hemoglobin,and troponin I were higher than those in the death group(all P＜0.05).Multivariate Cox regression analysis showed that solid tumor[hazard ratio(HR)=3.109,95％confidence interval(CI):1.133-8.530,P=0.028],acute liver failure(HR=2.430,95％CI:1.072-5.511,P=0.033)and APACHE Ⅱ score(HR=1.216,95％CI:1.149-1.286,P＜0.001)were the independent risk factors.However,early appropriate use of antibiotics could reduce the mortality rate,and it was an independent protective factor(HR=0.269,95％CI:0.123-0.590,P=0.001).Conclusions Solid tumor,acute liver failure and APACHE Ⅱ score are the independent risk factors for the elderly emergency patients with Gram-negative bacteria bloodstream infection,and early appropriate use of antibiotics can reduce the mortality rate.
Keywords：Bloodstream infectionElderly emergency patientsGram-negative bacteriaRisk factors
Publication Date：2024-10-08
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)
Pages：5( 1499-1503 )