Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA.
J Am Geriatr Soc. 2011 Apr;59(4):622-7. doi: 10.1111/j.1532-5415.2010.03289.x. Epub 2011 Mar 2.
To identify predictors and construct a prediction model for nosocomial bloodstream infection (BSI) in older adults.
Retrospective case-control study.
Hospitals belonging to the Duke Infection Control Outreach Network.
Patients age 65 and older with a nosocomial BSI and matched uninfected controls.
Multiple variables were captured and compared between groups. Independent predictors were identified using conditional logistic regression. A prediction model and score was constructed.
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.
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.
确定老年住院患者血流感染（BSI）的预测因素，并构建预测模型。
回顾性病例对照研究。
属于杜克感染控制拓展网络的医院。
年龄 65 岁及以上的医院获得性 BSI 患者和匹配的未感染对照。
在两组之间比较并捕获多个变量。使用条件逻辑回归确定独立预测因素。构建预测模型和评分。
830 例病例与 830 例对照进行比较。81%的医院获得性血流感染与导管相关（CRBSI）。耐甲氧西林金黄色葡萄球菌（MRSA）是最常见的分离病原体（23%）。老年住院患者发生医院获得性 BSI 的独立预测因素为男性、肥胖、入院时的 McCabe 评分低、入院时存在中心静脉置管、入院时存在胃造口术、近期手术和尿失禁。评分大于 11 分（总分为 23 分）的预测模型提示感染。
MRSA 是老年患者 CRBSI 的常见原因。男性、肥胖、入院时存在中心静脉置管、胃造口管和尿失禁是住院老年患者 BSI 的独立预测因素。本研究构建的预测模型应在不同队列中进行前瞻性验证。
