Background
Methods
Ethics statement
Study design and patient population
Definitions
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received intravenous therapy at home, wound care or specialized nursing care through a healthcare agency, family or friends; or, self-administered intravenous medical therapy in the 30 day period before the onset of the infection;
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attended a hospital or haemodialysis clinic, or received intravenous chemotherapy in the previous 30 days;
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were hospitalized in an acute care hospital for 2 or more days in the previous 90 days;
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resided in a nursing home or long-term care facility.
Statistical analysis
Results
Variable | Total | Dead at 5 years | Crude OR (95% CI) | p value |
---|---|---|---|---|
Age, median ± SD, years | 65 ± 20 | 74 ± 14 | 1.05 (1.04–1.05), per year | < 0.001 |
Female, n (%) | 517 (51) | 190 (50) | 1.06 (0.82–1.37) | 0.656 |
Underlying conditions, n (%) | ||||
Diabetes mellitus | 198 (20) | 85 (22) | 1.33 (0.97–1.83) | 0.074 |
Atherosclerosis | 236 (23) | 127 (34) | 2.43 (1.80–3.27) | < 0.001 |
Immunosuppression | 219 (22) | 75 (20) | 0.84 (0.61–1.15) | 0.274 |
Chemotherapy | 35 (4) | 26 (7) | ||
Radiotherapy | 8 (1) | 6 (2) | ||
Long-term corticoid | 168 (17) | 46 (12) | ||
Short-term corticoid | 22 (2) | 11 (3) | ||
HIV positive (non-AIDS) | 6 (1) | 1 (0) | ||
AIDS | 3 (0) | 2 (1) | ||
Chronic liver disease | 22 (2) | 14 (4) | 3.00 (1.25–7.22) | 0.014 |
Chronic heart failure | 74 (7) | 44 (12) | 2.64 (1.63–4.29) | < 0.001 |
Chronic respiratory disease | 66 (7) | 43 (11) | 3.40 (2.01–5.74) | < 0.001 |
Chronic kidney disease | 148 (15) | 56 (15) | 1.02 (0.71–1.46) | 0.908 |
End Stage kidney disease | 69 (7) | 23 (6) | 0.83 (0.49–1.39) | 0.469 |
Cancer | 45 (4) | 36 (10) | 7.29 (3.47–15.41) | < 0.001 |
Haematologic cancer | 59 (6) | 35 (9) | 2.59 (1.51–4.42) | 0.001 |
No comorbidities | 352 (35) | 78 (21) | 0.34 (0.25–0.46) | < 0.001 |
Karnofsky Index < 70 | 311 (31) | 195 (52) | 4.73 (3.56–6.29) | < 0.001 |
Type of infection | < 0.001 | |||
Community | 483 (48) | 144 (38) | 1.0 | |
Healthcare associated | 219 (22) | 106 (28) | 2.21 (1.59–3.07) | |
Hospital-acquired | 311 (31) | 129 (34) | 1.67 (1.24–2.25) | |
Severity of infection | < 0.001 | |||
Infection | 275 (27) | 86 (23) | 1.0 | |
Sepsis | 355 (35) | 125 (33) | 1.19 (0.85–1.67) | |
Severe sepsis | 292 (29) | 116 (31) | 1.45 (1.02–2.05) | |
Septic shock | 91 (9) | 52 (14) | 2.93 (1.80–4.77) | |
SAPS II score, per point | 29 ± 13 | 35 ± 14 | 1.07 (1.06–1.09) | < 0.001 |
SOFA score, per point | 2 ± 3 | 3 ± 3 | 1.11 (1.06–1.16) | < 0.001 |
Focus of infection | 0.043 | |||
Respiratory | 407 (40) | 156 (41) | 1.0 | |
Urinary | 339 (34) | 134 (35) | 1.05 (0.78–1.41) | |
Abdominal | 209 (21) | 62 (16) | 0.68 (0.47–0.97) | |
Other | 19 (2) | 14 (4) | 1.40 (0.81–2.43) | |
Microbiologic documentation | 691 (68) | 276 (73) | 1.41 (1.07–1.87) | 0.015 |
Positive blood cultures | 151 (15) | 70 (19) | 1.55 (1.09–2.19) | 0.014 |
Infection by a MDR pathogen | 322 (51) | 146 (56) | 1.42 (1.03–1.95) | 0.031 |
Infection by an ESKAPE pathogen | 113 (18) | 61 (24) | 1.88 (1.25–2.83) | 0.003 |
Inappropriate antibiotherapy | 144 (21) | 73 (26) | 1.74 (1.20–2.52) | 0.003 |
Isolated microorganisms, n (%) | Total | Dead at 5 years |
---|---|---|
Community-acquired infection | 272 (56) | 93 (65) |
Escherichia coli | 101 (10) | 39 (10) |
Streptococcus pneumoniae | 59 (6) | 18 (5) |
Haemophilus influenza | 17 (2) | 3 (1) |
Proteus mirabillis | 12 (1) | 5 (1) |
Klebsiella pneumoniae | 11 (1) | 5 (1) |
Pseudomonas aeroginosa | 10 (10) | 5 (1) |
Enterococcus faecium | 7 (0) | 4 (1) |
MSSA | 7 (0) | 2 (1) |
Legionella pneumophyla | 6 (0) | 0 (0) |
Other | 42 (4) | 21 (6) |
ESKAPE | 10 (10) | 5 (1) |
MDR | 79 (8) | 36 (10) |
Healthcare-associated infection | 160 (73) | 76 (72) |
Escherichia coli | 69 (7) | 29 (8) |
MSSA | 21 (2) | 9 (2) |
Klebsiella pneumoniae | 15 (2) | 6 (2) |
Pseudomonas aeroginosa | 11 (1) | 6 (2) |
Enterococcus faecalis | 9 (0) | 4 (1) |
MRSA | 8 (0) | 6 (2) |
Proteus mirabillis | 7 (0) | 4 (1) |
Streptococcus pneumoniae | 7 (0) | 5 (1) |
Enterococcus faecium | 6 (0) | 4 (1) |
Other | 31 (3) | 18 (5) |
ESKAPE | 30 (3) | 16 (4) |
MDR | 85 (8) | 44 (12) |
Hospital-acquired infection | 259 (833) | 107 (83) |
Escherichia coli | 68 (7) | 24 (6) |
Pseudomonas aeroginosa | 37 (4) | 18 (2) |
MRSA | 30 (3) | 18 (5) |
Enterococcus faecalis | 24 (2) | 9 (2) |
Klebsiella pneumoniae | 23 (2) | 7 (2) |
MSSA | 18 (2) | 3 (1) |
Proteus mirabillis | 17 (2) | 8 (2) |
Enterobacter cloacae | 16 (2) | 8 (0) |
Acinetobacter baumanni | 13 (1) | 4 (0) |
Enterococcus faecium | 13 (1) | 7 (2) |
Candida albicans | 7 (0) | 0 (0) |
Morganella morganni | 6 (0) | 1 (0) |
Clostridium difficile | 5 (0) | 3 (1) |
Enterobacter aerogenes | 5 (0) | 2 (1) |
Serratia marcescens | 5 (0) | 3 (1) |
Other | 24 (2) | 14 (4) |
ESKAPE | 73 (7) | 10 (3) |
MDR | 158 (16) | 79 (21) |
Variable | Total | Dead at 5 years | Adjusted OR (95% CI) | |
---|---|---|---|---|
Model 1 | Model 2 | |||
Age, mean ± SD, per year | 65 ± 20 | 74 ± 14 | 1,03 (1.02–1.04) | 1,04 (1.03–1.05) |
Cancer, n (%) | 45 (4) | 36 (10) | 4.36 (1.65– 11.53) | 5.93 (2.26– 15.51) |
Chronic haematologic disease, n (%) | 59 (6) | 35 (9) | 2.37 (1.14–4.93) | |
No comorbidities, n (%) | 352 (35) | 78 (21) | 0.40 (0.26–0.62) | 0.45 (0.29–0.69) |
Karnofsky Index < 70, n (%) | 311 (31) | 195 (52) | 2.25 (1.48–3.40) | 2.32 (1.54–3.50) |
Severity of infection, n (%) | ||||
Infection | 275 (27) | 86 (23) | 1.00 | |
Sepsis | 355 (35) | 125 (33) | 1.15 (0.72–1.83) | |
Severe sepsis | 292 (29) | 116 (31) | 1.33 (0.81– 2.17) | |
Septic shock | 91 (9) | 52 (14) | 3.77 (1.80– 7.89) | |
SAPS II, median ± SD, per point | 29 ± 13 | 35 ± 14 | 1.05 (1.03–1.07) | |
Positive blood cultures, n (%) | 151 (15) | 70 (19) | 1.57 (1.01–2.44) | |
Infection by an ESKAPE pathogen, n (%) | 113 (18) | 61 (24) | 1.61 (1.00–2.60) | 1.61 (1.00–2.60) |
Variable | Total (n = 876) | Dead at 5 years (n = 243) | Crude OR (95% CI) | p value | Adjusted OR (95% CI) |
---|---|---|---|---|---|
Age, median ± SD, years | 63 ± 20 | 73 ± 14 | 1.04 (1.03–1.05), per year | < 0.001 | 1.03, per year (1.02–1.05) |
Female, n (%) | 458 (52) | 132 (54) | 0.89 (0.66–1.20) | 0.454 | |
Underlying conditions, n (%) | |||||
Diabetes mellitus | 183 (21) | 70 (29) | 1.86 (1.32–2.63) | < 0.001 | 1.65 (1.06–2.56) |
Atherosclerosis | 283 (21) | 74 (31) | 2.11 (1.50–2.96) | < 0.001 | |
Immunosuppression | 195 (22) | 51 (21) | 0.90 (0.63–1.29) | 0.575 | |
Chemotherapy | 26 (3) | 17 (7) | |||
Radiotherapy | 6 (1) | 4 (2) | |||
Long-term corticoid | 166 (18) | 34 (14) | |||
Short-term corticoid | 16 (2) | 5 (2) | |||
HIV positive (non-AIDS) | 6 (1) | 1 (0) | |||
AIDS | 2 (0) | 1 (0) | |||
Chronic liver disease | 14 (2) | 6 (3) | 1.98 (0.68–5.76) | 0.211 | |
Chronic heart failure | 62 (7) | 33 (14) | 3.27 (1.94–5.52) | < 0.001 | |
Chronic respiratory disease | 66 (7) | 43 (11,4) | 4.17 (2.39–7.26) | < 0.001 | 2.27 (1.09–4.69) |
Chronic kidney disease | 138 (16) | 46 (19) | 1.37 (0.93–2.03) | 0.111 | |
End Stage kidney disease | 66 (8) | 20 (8) | 1.14 (0.66–1.98) | 0.639 | |
Cancer | 27 (3) | 18 (7) | 5.55 (2.46–12.53) | < 0.001 | 4.69 (1.71–12.83) |
Haematologic cancer | 42 (5) | 18 (7) | 2.03 (1.08–3.81) | 0.028 | |
No comorbidities | 322 (37) | 48 (20) | 0.32 (0.23–0.46) | < 0.001 | |
Karnofsky Index < 70 | 230 (26) | 115 (47) | 4.05 (2.93–5.59) | < 0.001 | 2.50 (1.63–3.83) |
Type of infection | < 0.001 | ||||
Community | 436 (50) | 97 (40) | 1.0 | ||
Healthcare associated | 187 (21) | 75 (31) | 2.34 (1.62–3.39) | ||
Hospital-acquired | 253 (29) | 71 (29) | 1.36 (0.96–1.95) | ||
Severity of infection | 0.61 | ||||
Infection | 255 (29) | 66 (27) | 1.0 | ||
Sepsis | 325 (37) | 96 (40) | 1.20 (0.83–1.73) | ||
Severe sepsis | 246 (28) | 70 (29) | 1.14 (0.77–1.67) | ||
Septic shock | 50 (6) | 11 (5) | 0.80 (0.39–1.67) | ||
SAPS II score, per point | 27 ± 10 | 31 ± 9 | 1.05 (1.03–1.06) | < 0.001 | |
SOFA score, per point | 2 ± 2 | 2 ± 2 | 0.99 (0.93–1.06) | 0.771 | |
Focus of infection | 0.005 | ||||
Respiratory | 345 (39) | 94 (39) | 1.0 | ||
Urinary | 304 (35) | 100 (41) | 1.31 (0.94–1.83) | ||
Abdominal | 280 (21) | 33 (14) | 0.60 (0.38–0.94) | ||
Other | 47 (5) | 16 (7) | 1.38 (0.72–2.64) | ||
Microbiologic documentation | 593 (68) | 179 (74) | 1.48 (1.07–2.06) | 0.020 | |
Positive blood cultures | 126 (14) | 46 (19) | 1.61 (1.09–2.40) | 0.018 | 1.66 (1.04–2.64) |
Infection by a MDR pathogen | 265 (49) | 89 (53) | 1.24 (0.86–1.79) | 0.245 | |
Infection by an ESKAPE pathogen | 82 (15) | 30 (18) | 1.33 (0.81–2.17) | 0.256 | |
Inappropriate antibiotherapy | 113 (19) | 43 (24) | 1.55 (1.01–2.39) | 0.044 |