印度老年人的传染病紧急情况：一项比较最年轻老人、中年老人和最年长老人患者的前瞻性观察研究
Infectious Disease Emergencies in Older Adults in India: A Prospective Observational Study Comparing Youngest Old, Middle Old, and Oldest Old Patients.
作者信息
Kadar Hasan, Erla Sathvik R, Angrup Archana, Bhatia Mandip, Sharma Navneet, Pannu Ashok K
机构信息
Department of Internal Medicine (Acute Care and Emergency Medicine Unit), Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India.
Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
出版信息
Indian J Crit Care Med. 2025 Jul;29(7):569-577. doi: 10.5005/jp-journals-10071-25000. Epub 2025 Jul 7.
BACKGROUND AND AIMS
Infections remain a common cause of emergency department (ED) admissions in older adults, particularly in low and middle-income countries. This study investigates the clinical and microbiological spectrum and outcomes of infection-related emergencies in older adults in North India, comparing the youngest old (65-74 years), middle old (75-84 years), and oldest old (≥85 years) patients.
PATIENTS AND METHODS
This prospective observational study included older patients (≥65 years) with community-acquired infections admitted to the medical ED of a tertiary care academic hospital in North India from June 2023 to May 2024. Patients with hospital-acquired infections, including those that developed during prior admissions at referring hospitals, were excluded.
RESULTS
We enrolled 300 patients (mean age 74.2 years, 51% males), including 164 youngest old, 92 middle old, and 44 oldest old. The most prevalent infections were pneumonia (39.3%), urinary tract infection (UTI) (13.3%), cholangitis (9.3%), and tuberculosis (7.7%). Microbiological confirmation was achieved in 37.3%, with frequent isolation of drug-resistant organisms such as , and . The oldest old group presented more acutely with severe illness and had a higher incidence of pneumonia (56.8%), lower UTI rates (2.3%), and fewer microbiological diagnoses (13.6%). In-hospital mortality was 32.0%, highest in pneumonia (47.1%) and tuberculosis (47.8%), and lowest in UTI (14.7%). Baseline Acute Physiology and Chronic Health Evaluation (APACHE)-II score independently predicted mortality (OR 1.081, 95% CI: 1.013-1.153, = 0.019).
CONCLUSION
Infection-related emergencies in older adults, especially the oldest old, pose diagnostic challenges and carry high mortality. Pneumonia is a major cause of ED admission and death among older adults in India.
HOW TO CITE THIS ARTICLE
Kadar H, Erla SR, Angrup A, Bhatia M, Sharma N, Pannu AK. Infectious Disease Emergencies in Older Adults in India: A Prospective Observational Study Comparing Youngest Old, Middle Old, and Oldest Old Patients. Indian J Crit Care Med 2025;29(7):569-577.
背景与目的
感染仍是老年人急诊入院的常见原因，在低收入和中等收入国家尤其如此。本研究调查了印度北部老年人感染相关急症的临床和微生物学特征及预后，比较了最年轻的老年人（65 - 74岁）、中年老年人（75 - 84岁）和最年长的老年人（≥85岁）患者。
患者与方法
这项前瞻性观察性研究纳入了2023年6月至2024年5月期间在印度北部一家三级医疗学术医院的急诊科因社区获得性感染入院的老年患者（≥65岁）。排除医院获得性感染患者，包括在转诊医院先前住院期间发生的感染患者。
结果
我们纳入了300例患者（平均年龄74.2岁，51%为男性），其中164例为最年轻的老年人，92例为中年老年人，44例为最年长的老年人。最常见的感染是肺炎（39.3%）、尿路感染（UTI）（13.3%）、胆管炎（9.3%）和结核病（7.7%）。37.3%的患者获得了微生物学确诊，常见分离出耐药菌，如 、 和 。最年长的老年人群体病情表现更为急重，肺炎发病率更高（56.8%），下尿路感染率更低（2.3%），微生物学诊断更少（13.6%）。住院死亡率为32.0%，肺炎（47.1%）和结核病（47.8%）中最高，尿路感染（14.7%）中最低。基线急性生理与慢性健康状况评估（APACHE）-II评分独立预测死亡率（OR 1.081，95% CI：1.013 - 1.153，P = 0.019）。
结论
老年人尤其是最年长的老年人感染相关急症带来诊断挑战且死亡率高。肺炎是印度老年人急诊入院和死亡的主要原因。
如何引用本文
Kadar H, Erla SR, Angrup A, Bhatia M, Sharma N, Pannu AK. 印度老年人的传染病急症：一项比较最年轻、中年和最年长患者的前瞻性观察研究。《印度重症医学杂志》2025；29(7):569 - 577。
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