Nosocomial infection and risk factors in elderly patients in intensive care units

Abstract

Objective: Gradually increase in patients over 65 year age accounts a spesific population for nosocomial infections. Predisposition to infections in this age group is a result of impaired host defence such as diminished cellular immunity. Despite the importance of this fact there is not much data about the incidence and risk factors of nosocomial infections in elderly. The purpose of this study is to investigate the risk factors, the factors effecting mortality and incidence of nosocomial infections in elderly patients in the medical ICUs of our hospital. Methods: The patients treated over 48 hours at four ICU's between January and December 2008 were enrolled in the study. Data were collected by active prospective surveillance. Elderly and adult patients were compared according to the factors effecting the development of nosocomial infection, causative agents, and mortality rates. Moreover, elderly patients with/without nosocomial infection were compared for the risk factors. Results: A total of 433 patients were included in the study. 288 of the patients were over 65, and 205 of them were 18-65 age. The incidence of nosocomial infection was found 51% in the elderly group and 48.8% in the adult group. There was no difference in the incidence of nosocomial infection between the elderly and adult groups. The presence of diabetes, COPD and chronic diseases were statistically higher in the elderly patients with nosocomial infection. Pneumonia was the most frequent nosocomial infection in both groups, and mechanical ventilator utilisation was found to be high in both groups. Mortality rate and duration of hospitalization were found significantly higher in patients with nosocomial infection than those of without nosocomial infection. Increased age, lenghtheded duration of hospitalization, deterioration of conscious, existence of underlying chronic diseases, the presence nosocomial infection and malignancy as well as the use of MV and CVC are found to be independent risk factors for mortality. Conclusion: Nosocomial infection incidence among the elderly patients in ICUs was high but not statistically different than the adult patients in our study. However, the mortality was significantly higher in elderly group. We found that use of invasive techniques were related with increase in the incidence of nosocomial infections. Limited application of invasive procedures will make a contribution to decrease these infections.