Presentation, management, and outcomes of older compared to younger adults with hospital-acquired bloodstream infections in the intensive care unit: a multicenter cohort study
Authors: Margalit Ili , Yahav Dafna , Hoffman Tomer , Tabah Alexis , Ruckly Stéphane , Barbier François , Singer Pierre , Timsit Jean-François , Prendki Virginie , Buetti Niccolò ,   the EUROBACT-2 Study Group, the European Society of Intensive Care Medicine (ESICM), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Groups for Infections in Critically Ill Patients (ESGCIP) and Infections in the Elderly (ESGIE), and the OUTCOMEREA Network, Lipman Jeffrey , Pollock Hamish , Margetts Ben , Udy Andrew , Young Meredith , Bhadange Neeraj , Tyler Steven , Ledtischke Anne , Finnis Mackenzie , Dwivedi Jyotsna , Saxena Manoj , Biradar Vishwanath , Soar Natalie , Sarode Vineet , Brewster David , Regli Adrian , Weeda Elizabeth , Ahmed Samiul , Fourie Cheryl , Laupland Kevin , Ramanan Mahesh , Walsham James , Meyer Jason , Litton Edward , Palermo Anna Maria , Yap Timothy , Eroglu Ege , Attokaran Antony George , Jaramillo C’havala , Nafees Khalid Mahmood Khan , Rashid Nurhikmahtul Aqilah Haji Abd , Walid Haji Adi Muhamad Ibnu , Mon Tomas , Moorthi P. Dhakshina , Sudhirchandra Shah , Sridharan Dhadappa Damodar , Haibo Qiu , Jianfeng Xie , Wei-Hua Lu , Zhen Wang , Qian Chuanyun , Luo Jili , Chen Xiaomei , Wang Hao , Zhao Peng , Zhao Juan , Wusi Qiu , Mingmin Chen , Xu Lei , Yin Chengfen , Wang Ruilan , Wang Jinfeng , Yin Yongjie , Zhang Min , Ye Jilu , Hu Chungfang , Zhou Suming , Huang Min , Yan Jing , Wang Yan , Qin Bingyu , Ye Ling , Weifeng Xie , Peije Li , Geng Nan , Ling Lowell , Hayashi Yoshiro , Karumai Toshiyuki , Yamasaki Masaki , Hashimoto Satoru , Hosokawa Koji , Makino Jun , Matsuyoshi Takeo , Kuriyama Akira , Shigemitsu Hidenobu , Mishima Yuka , Nagashima Michio , Yoshida Hideki , Omori Koichiro , Rinka Hiroshi , Saito Hiroki , Atobe Kaori , Kato Hideaki , Takaki Shunsuke , Hasan M. Shahnaz , Jamaluddin Muhamad Fadhil Hadi , Pheng Lee See , Visvalingam Sheshendrasurian , Liew Mun Thing , Wong Siong Ling Danny , Fong Kean Khang , Rahman Hamizah Bt Abdul , Noor Zuraini Md , Tong Lee Kok , Azman Abd. Hamid , Mazlan Mohd Zulfakar , Ali Saedah , Abello Anton , Jeon Kyeongman , Lee Sang-Min , Park Sunghoon , Park Seung Yong , Lim Sung Yoon , Goh Qing Yuan , Ng Shin Yi , Lie Sui An , Kwa Andrea Lay Hoon , Goh Ken Junyang , Li Andrew Yunkai , Ong Caroline Yu Ming , Lim Jia Yan , Quah Jessica Lishan , Ng Kangqi , Ng Louis Xiang Long , Yeh Yu Chang , Chou Nai-Kuan , Cia Cong-Tat , Hu Ting-Yu , Kuo Li-Kuo , Ku Shih-Chi , Wongsurakiat Phunsup , Apichatbutr Yutthana , Chiewroongroj Supattra , Nadeem Rashid , El Houfi Ashraf , Alsisi Adel , Elhadidy Amr , Barsoum Mina , Osman Nermin , Mostafa Tarek , Elbahnasawy Mohamed , Saber Ahmed , Aldhalia Amer , Elmandouh Omar , Elsayed Ahmed , Elbadawy Merihan A. , Awad Ahmed K. , Hemead Hanan M. , Zand Farid , Ouhadian Maryam , Borsi Seyed Hamid , Mehraban Zahra , Kashipazha Davood , Ahmadi Fatemeh , Savaie Mohsen , Soltani Farhad , Rashidi Mahboobeh , Baghbanian Reza , Javaherforoosh Fatemeh , Amiri Fereshteh , Kiani Arash , Zargar Mohammad Amin , Mahmoodpoor Ata , Aalinezhad Fatemeh , Dabiri Gholamreza , Sabetian Golnar , Sarshad Hakimeh , Masjedi Mansoor , Tajvidi Ramin , Nasirodin Seyed Mohammad , Ahmed Abdullah Khudhur , Kagan Ilya , Rigler Merav , Belman Daniel , Levin Phillip , Harara Belal , Diab Adei , Abilama Fayez , Ibrahim Rebecca , Fares Aya , Buimsaedah Ahmad , Gamra Marwa , Aqeelah Ahmed , Ali Almajdoub Ali Mohammed , Homaidan Ahmed Gaber Sadik , Almiqlash Bushray , Bilkhayr Hala , Bouhuwaish Ahmad , Taher Ahmed Sa , Abdulwahed Eman , Abousnina Fathi A. , Hdada Aisha Khaled , Jobran Rania , Hasan Hayat Ben , Hasan Rabab Shaban Ben , Serghini Issam , Seddiki Rachid , Boukatta Brahim , Kanjaa Nabil , Mouhssine Doumiri , Wajdi Maazouzi Ahmed , Dendane Tarek , Zeggwagh Amine Ali , Housni Brahim , Younes Oujidi , Hachimi Abdelhamid , Ghannam A. , Belkhadir Z. , Amro Sarah , Jayyab Mustafa Abu , Hssain Ali Ait , Elbuzidi Abdurahaman , Karic Edin , Lance Marcus , Nissar Shaikh , Sallam Hend , Elrabi Omar , Almekhlafi Ghaleb A. , Awad Maher , Aljabbary Ahmed , Chaaban Mohammad Karam , Abu-Sayf Natalia , Kiwan Mazzeh , Al-Jadaan Mohammad , Bakr Lubna , Bouaziz Mounir , Turki Olfa , Sellami Walid , Centeno Pablo , Acevedo José Oscar , Lopez Patricia Mabel , Fernández Rubén , Segura Matías , Nuccetelli Yanina , Montefiore Pablo , Reyes Luis Felipe , Ñamendys-Silva Silvio A. , Romero-Gonzalez Juan P. , Hermosillo Mariana , Castillo Roberto Alejandro , Leal Jesús Nicolás Pantoja , Aguilar Candy Garcia , Herrera Mara Ocotlan Gonzalez , Lomeli-Teran Missael Vladimir Espinoza Villafuer , Dominguez-Cherit Jose G. , Davalos-Alvarez Adrian , Sánchez-Hurtado Luis , Tejeda-Huezo Brigitte , Perez-Nieto Orlando R. , Tomas Ernesto Deloya , Francois Guy , De Bus Liesbet , De Waele Jan , Hollevoet Isabelle , Denys Wouter , Bourgeois Marc , Mesland Jean-Baptiste , Henin Pierre , Haentjens Lionel , Biston Patrick , Noel Cindérella , Layos Nathalie , Misset Benoît , De Schryver Nicolas , Serck Nicolas , Wittebole Xavier , De Waele Elisabeth , Opdenacker Godelive , Kovacevic Pedja , Zlojutro Biljana , Custovic Aida , Filipovic-Grcic Ina , Radonic Radovan , Brajkovic Ana Vujaklija , Persec Jasminka , Sakan Sanja , Nikolic Mario , Lasic Hrvoje , Ruppe Etienne , Ruckly Stephane , Montravers Philippe , Leone Marc , Arbelot Charlotte , Patrier Mme Juliette , Zappela N. , Montravers P. , Dulac Thierry , Castanera Jérémy , Auchabie Johann , Le Meur Anthony , Marchalot A. , Beuzelin M. , Massri Alexandre , Guesdon Charlotte , Escudier Etienne , Mateu Philippe , Rosman Jérémy , Leroy Olivier , Alfandari Serge , Nica Alexandru , Souweine Bertrand , Coupez Elisabeth , Duburcq Thibault , Kipnis Eric , Bortolotti Perrine , Le Souhaitier Mathieu , Mira Jean-Paul , Garcon Pierre , Duprey Matthieu , Thyrault Martial , Paulet Rémi , Philippart François , Tran Marc , Bruel Cédric , Weiss Emmanuel , Janny Sylvie , Foucrier Arnaud , Perrigault Pierre-François , Djanikian Flora , Gainnier Marc , Bourenne Jérémy , Louis Guillaume , Smonig Roland , Argaud Laurent , Baudry Thomas , Dessap Armand Mekonted , Razazi Keyvan , Kalfon Pierre , Badre Gaëtan , Larcher Romaric , Lefrant Jean-Yves , Roger Claire , Sarton Benjamine , Silva Stein , Demeret Sophie , Le Guennec Loïc , Siami Shidasp , Aparicio Christelle , Voiriot Guillaume , Fartoukh Muriel , Dahyot-Fizelier Claire , Imzi Nadia , Klouche Kada , Bracht Hendrik , Hoheisen Sandra , Bloos Frank , Thomas-Rueddel Daniel , Petros Sirak , Pasieka Bastian , Dubler Simon , Schmidt Karsten , Gottschalk Antje , Wempe Carola , Lepper Philippe , Metz Carlos , Viderman Dmitriy , Umbetzhanov Yerlan , Mugazov Miras , Bazhykayeva Yelena , Kaligozhin Zhannur , Babashev Baurzhan , Merenkov Yevgeniy , Temirov Talgat , Arvaniti Kostoula , Smyrniotis Dimitrios , Psallida Vasiliki , Fildisis Georgios , Kaimakamis Evangelos , Iasonidou Cristina , Papoti Sofia , Vasileiou Maria , Romanou Vasiliki , Koutsoukou Vasiliki , Matei Mariana Kristina , Moldovan Leora , Karaiskos Ilias , Paskalis Harry , Marmanidou Kyriaki , Papanikolaou M. , Kampolis C. , Oikonomou Marina , Kogkopoulos Evangelos , Nikolaou Charikleia , Sakkalis Anastasios , Chatzis Marinos , Georgopoulou Maria , Efthymiou Anna , Chantziara Vasiliki , Sakagianni Aikaterini , Athanasa Zoi , Papageorgiou Eirini , Ali Fadi , Dimopoulos Georges , Almiroudi Mariota Panagiota , Malliotakis Polychronis , Marouli Diamantina , Theodorou Vasiliki , Retselas Ioannis , Kouroulas Vasilios , Papathanakos Georgios , Sales Gabriele , De Pascale Gennaro , Montini Luca Maria , Carelli Simone , Vargas Joel , Di Gravio Valentina , Giacobbe Daniele Roberto , Gratarola Angelo , Porcile Elisa , Mirabella Michele , Daroui Ivan , Lodi Giovanni , Zuccaro Francesco , Schlevenin Maria Grazia , Pelosi Paolo , Battaglini Denise , Cortegiani Andrea , Ippolito Mariachiara , Bellina Davide , Di Guardo Andrea , Pelagalli Lorella , Covotta Marco , Rocco Monica , Fiorelli Silvia , Rizzo Anna Chiara , Mikstacki Adam , Tamowicz Barbara , Komorowska Irmina Kaptur , Szczesniak Anna , Opolu Szpital Wojewodzki W. , Bojko Jozef , Kotkowska Anna , Walczak-Wieteska Paulina , Wasowska Dominika , Nowakowski Tomasz , Broda Hanna , Peichota Mariusz , Pietraszek-Grzywaczewska Iwona , Martin-Loeches Ignacio , Bisanti Alessandra , Póvoa Pedro , Cartoze Nuno , Pereira Tiago , Alves Madalena , Marques Ana Josefina Pinheiro , Pinto Ana Rios , Krystopchuk Andriy , Teresa Ana , De Almeida Jose , de Figueiredo António Manuel Pereira , Botelho Isabel , Duarte Tiago , Costa Vasco , Cunha Rui Pedro , Molinos Elena , da Costa Tito , Ledo Sara , Queiró Joana , Pascoalinho Dulce , Nunes Cristina , Moura José Pedro , Pereira Énio , Mendes António Carvalho , Iliescu C. C. , Valeanu Liana , Bubenek-Turconi Serban , Grintescu Ioana Marina , Cobilinschi Cristian , Filipescu Daniela Carmen , Predoi Cornelia Elena , Tomescu Dana , Popescu Mihai , Marcu Alexandra , Grigoras Ioana , Lungu Olguta , Gritsan Alexey , Anderzhanova Anastasia , Meleshkina Yulia , Magomedov Marat , Perm E. A. Vagner , Zubareva Nadezhda , Tribulev Maksim , Gaigolnik Denis , Eremenko Aleksan , Vistovskaya Natala , Chukina Maria , Belskiy Vladislav , Furman Mikhail , Rocca Ricard Ferrer , Martinez Maria , Casares Vanessa , Artigas Ricard Mellado , Vera Paula , Flores Matias , Amerigo Joaquin Amador , Arnillas Maria Pilar Gracia , Bermudez Rosana Munoz , Armestar Fernando , Catalan Beatriz , Roig Regina , Raguer Laura , Quesada María Dolores , Santos Emilio Diaz , Gomà Gemma , Ubeda Alejandro , Salgado Maria , Espina Lorena Forcelledo , Prieto Emilio Garcia , Asensio M. J. , Rodriguez M. , Maseda Emilio , De La Rica Alejandro Suarez , Ayestaran J. Ignacio , Novo Mariana , Blasco-Navalpotro Miguel Angel , Gallego Alberto Orejas , Sjövall Fredrik , Spahic Dzana , Svensson Carl Johan , Haney Michael , Edin Alicia , Åkerlund Joyce , De Geer Lina , Prazak Josef , Chuv Stephan Jakob , Pagani Jl , Abed-Maillard S. , Akova Murat , Aslan Abdullah Tarik , Timuroglu Arif , Kocagoz Sesin , Kusoglu Hulya , Mehtap Selcuk , Ceyhun Solakoğlu , Altintas Neriman Defne , Talan Leyla , Kayaaslan Bircan , Kalem Ayşe Kaya , Kurt Ibrahim , Telli Murat , Ozturk Barcin , Erol Çiğdem , Demiray Emine Kubra Dindar , Çolak Sait , Akbas Türkay , Gundogan Kursat , Sari Ali , Agalar Canan , Çolak Onur , Baykam Nurcan , Akdogan Ozlem , Yilmaz Mesut , Tunay Burcu , Cakmak Rumeysa , Saltoglu Nese , Karaali Ridvan , Koksal Iftihar , Aksoy Firdevs , Kartal Ahmet Eroglu , Kirdar Lutfi , Saracoglu Kemal Tolga , Bilir Yeliz , Guzeldag Seda , Ersoz Gulden , Evik Guliz , Sungurtekin Hulya , Ozgen Cansu , Erdoğan Cem , Gürbüz Yunus , Altin Nilgün , Bayindir Yasar , Ersoy Yasemin , Goksu Senay , Akyol Ahmet , Batirel Ayse , Aktas Sabahat Cagan , Morris Andrew Conway , Routledge Matthew , Ercole Ari , Antcliffe David , Rojo Roceld , Tizard Kate , Faulkner Maria , Cowton Amanda , Kent Melanie , Raj Ashok , Zormpa Artemis , Tinaslanidis George , Khade Reena , Torlinski Tomasz , Mulhi Randeep , Goyal Shraddha , Bajaj Manan , Soltan Marina , Yonan Aimee , Dolan Rachael , Johnson Aimee , Macfie Caroline , Lennard James , Templeton Maie , Arias Sonia Sousa , Franke Uwe , Hugill Keith , Angell Hollie , Parcell Benjamin J. , Cobb Katherine , Cole Stephen , Smith Tim , Graham Clive , Cerman Jaroslav , Keegan Allison , Ritzema Jenny , Sanderson Amanda , Roshdy Ashraf , Szakmany Tamas , Baumer Tom , Longbottom Rebecca , Hall Daniel , Tatham Kate , Loftus S. , Husain A. , Black E. , Jhanji S. , Baikady R. Rao , Mcguigan Peter , Mckee Rachel , Kannan Santhana , Antrolikar Supriya , Marsden Nicholas , Torre Valentina Della , Banach Dorota , Zaki Ahmed , Jackson Matthew , Chikungwa Moses , Attwood Ben , Patel Jamie , Tilley Rebecca E. , Humphreys Sally K. , Renaud Paul Jean , Sokhan Anton , Burma Yaroslava , Sligl Wendy , Baig Nadia , McCoshen Lorena , Kutsogiannis Demetrios J. , Thompson Patricia , Hewer Tayne , Rabbani Raihan , Huq Shihan Mahmud Redwanul , Hasan Rajib , Islam Mohammad Motiul , Gurja Mohan , Baronia Arvind , Kothari Nikhil , Sharma Ankur , Karmakar Saurabh , Sharma Priya , Nimbolkar Janardan , Samdani Pratit , R Vaidyanathan , Rubina Noor Ahmedi , Jain Nikhilesh , Pahuja Madhumati , Singh Ritu , Muzaffar Syed Nabeel , Ozair Ahmad , Siddiqui Suhail Sarwar , Bose Payel , Datta Avijatri , Rathod Darshana , Patel Mayur , Renuka M. K. , Baby Sailaja K. , Dsilva Carol , Chandran Jagadish , Ghosh Pralay , Mukherjee Sudipta , Sheshala Kaladhar , Misra Krushna Chandra , Yakubu Saidu Yusuf , Ugwu Euphemia Mgbosoro , Olatosi John , Desalu Ibironke , Asiyanbi Gabriel , Oladimeji Motunrayo , Idowu Olusola , Adeola Fowotade , Mer Mervyn , Mc Cree Melanie , Karar Ali Adil Ali , Saidahmed Elfayadh , Hamid Hytham K. S. 
Published: June 2024

Abstract
Purpose
Older adults admitted to the intensive care unit (ICU) usually have fair baseline functional capacity, yet their age and frailty may compromise their management. We compared the characteristics and management of older (≥ 75 years) versus younger adults hospitalized in ICU with hospital-acquired bloodstream infection (HA-BSI).

Methods
Nested cohort study within the EUROBACT-2 database, a multinational prospective cohort study including adults (≥ 18 years) hospitalized in the ICU during 2019–2021. We compared older versus younger adults in terms of infection characteristics (clinical signs and symptoms, source, and microbiological data), management (imaging, source control, antimicrobial therapy), and outcomes (28-day mortality and hospital discharge).

Results
Among 2111 individuals hospitalized in 219 ICUs with HA-BSI, 563 (27%) were ≥ 75 years old. Compared to younger patients, these individuals had higher comorbidity score and lower functional capacity; presented more often with a pulmonary, urinary, or unknown HA-BSI source; and had lower heart rate, blood pressure and temperature at presentation. Pathogens and resistance rates were similar in both groups. Differences in management included mainly lower rates of effective source control achievement among aged individuals. Older adults also had significantly higher day-28 mortality (50% versus 34%, p < 0.001), and lower rates of discharge from hospital (12% versus 20%, p < 0.001) by this time.

Conclusions
Older adults with HA-BSI hospitalized in ICU have different baseline characteristics and source of infection compared to younger patients. Management of older adults differs mainly by lower probability to achieve source control. This should be targeted to improve outcomes among older ICU patients.