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Biscetti L, Cameriere V, Rossi T, Potente E, Sabbatini D, Bollettini F, Castellani S, Ferrara L, Galeazzi R, Lattanzio F, Di Rosa M, Foresi E, Pelliccioni G. Dementia, stroke, age, use of medical devices and antipsychotic drugs may increase the risk of nosocomial infections among elderly patients hospitalized at Neurology Clinics. Sci Rep 2023; 13:18687. [PMID: 37907588 PMCID: PMC10618180 DOI: 10.1038/s41598-023-46102-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/27/2023] [Indexed: 11/02/2023] Open
Abstract
Healthcare-acquired infections (HCAI) represent a major health problem worldwide. Stroke and dementia are considered risk factors for HCAI. Preliminary data suggest that use of antipsychotic drugs also increase the risk for HCAI. Here, we performed a retrospective study aimed at investigating the major risk and protective factors for HCAI in a cohort of elderly subjects hospitalized at an Italian tertiary Neurology Clinics. We included all patients with age ≥ 65 years hospitalized at Neurology Clinics of National Institute on Ageing, Ancona, Italy from 1st January 2018 to 31st December 2021. For each patient, the following data were collected: age, sex, use of medical devices, comorbidities, use of antipsychotic medications, development of HCAI. We included 1543 patients (41.4% males; median age 85 years [80-89]). According to multivariable analysis, age, stroke, duration of urinary catheter placement (for all p < 0.001) and midline placement (p = 0.035) resulted to be risk factors for HCAI, Diabetes resulted to be a protective factor for pneumonia (p = 0.041), while dementia and nasogastric tube were risks factor for this condition (p = 0.022 and p < 0.001, respectively). Urinary catheter was a risk factor for urinary tract infections (p < 0.001). Duration of placement of vascular catheters and use of antipsychotic drugs resulted to significantly increase the risk for bloodstream infections. Stroke, age and use of medical devices were confirmed to be risk factors for HCAI. Antipsychotic drugs resulted to increase risk for bloodstream infections. Further prospective studies will be needed to confirm these findings.
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Affiliation(s)
- Leonardo Biscetti
- Unit of Neurology, IRCCS INRCA-National Institute of Health and Science on Ageing, Ancona, Italy
| | - Valentina Cameriere
- Unit of Neurology, IRCCS INRCA-National Institute of Health and Science on Ageing, Ancona, Italy
| | - Tommaso Rossi
- Unit of Neurology, IRCCS INRCA-National Institute of Health and Science on Ageing, Ancona, Italy
| | - Eleonora Potente
- Unit of Neurology, IRCCS INRCA-National Institute of Health and Science on Ageing, Ancona, Italy
| | - Deborah Sabbatini
- Unit of Neurology, IRCCS INRCA-National Institute of Health and Science on Ageing, Ancona, Italy
| | - Francesco Bollettini
- Unit of Neurology, IRCCS INRCA-National Institute of Health and Science on Ageing, Ancona, Italy
| | - Simona Castellani
- Unit of Neurology, IRCCS INRCA-National Institute of Health and Science on Ageing, Ancona, Italy
| | - Letizia Ferrara
- Medical Direction, IRCCS INRCA-National Institute of Health and Science on Ageing, Ancona, Italy
| | - Roberta Galeazzi
- Clinic of Laboratory and Precision Medicine, IRCCS INRCA-National Institute of Health and Science on Ageing, Ancona, Italy
| | - Fabrizia Lattanzio
- Scientific Direction, IRCCS INRCA-National Institute of Health and Science on Ageing, Ancona, Italy
| | - Mirko Di Rosa
- Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, IRCCS INRCA-National Institute of Health and Science on Ageing, Ancona, Italy.
| | - Elisa Foresi
- Medical Direction, IRCCS INRCA-National Institute of Health and Science on Ageing, Ancona, Italy
| | - Giuseppe Pelliccioni
- Unit of Neurology, IRCCS INRCA-National Institute of Health and Science on Ageing, Ancona, Italy
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Muacevic A, Adler JR. Catheter-Associated Urinary Tract Infection (CAUTI). Cureus 2022; 14:e30385. [PMID: 36407206 PMCID: PMC9668204 DOI: 10.7759/cureus.30385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/17/2022] [Indexed: 01/25/2023] Open
Abstract
One of the most prevalent health-related illnesses globally is catheter-associated urinary tract infection (CAUTI). CAUTIs account for almost half of all hospital-acquired diseases. Most of the healthcare-acquired urinary tract infections result from catheter tubes implantation. These tubes connect a collecting system and the urinary bladder via the urethra. These are known as indwelling urinary catheters. The length of catheterization has a key role in starting bacteriuria since biofilm eventually forms on all of these devices. Despite the low percentage of people with bacteriuria who start showing symptoms, there is nevertheless a significant burden associated with these contamination due to the repeated use of indwelling urinary devices. Minimizing indwelling device usage and stopping the catheter as soon as medically possible are the two most crucial preventative measures for bacteriuria and infection when device use is required. Efforts to avoid catheter-acquired urinary infections must be implemented and monitored by infection control guidelines in healthcare institutions. These approaches include monitoring device use, the suitability of device justifications, and problems. Ultimately, technological advancements in device substances that inhibit colony generation will be necessary to avoid these infestations. There is still some way by which we can bring down the increased phenomenon of catheter-associated urinary tract contamination by maintaining hygiene while handling the catheter and patients and keeping the infected patients away or isolated from unaffected patients as a precaution. This article mainly focuses on an overview that helps with discussing prevention, risk factors, diagnosis, control and management of CAUTI.
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Møller JK, Sørensen M, Hardahl C. Prediction of risk of acquiring urinary tract infection during hospital stay based on machine-learning: A retrospective cohort study. PLoS One 2021; 16:e0248636. [PMID: 33788888 PMCID: PMC8011767 DOI: 10.1371/journal.pone.0248636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 03/02/2021] [Indexed: 11/19/2022] Open
Abstract
Background Healthcare associated infections (HAI) are a major burden for the healthcare system and associated with prolonged hospital stay, increased morbidity, mortality and costs. Healthcare associated urinary tract infections (HA-UTI) accounts for about 20–30% of all HAI’s, and with the emergence of multi-resistant urinary tract pathogens, the total burden of HA-UTI will most likely increase. Objective The aim of the current study was to develop two predictive models, using data from the index admission as well as historic data on a patient, to predict the development of UTI at the time of entry to the hospital and after 48 hours of admission (HA-UTI). The ultimate goal is to predict the individual patient risk of acquiring HA-UTI before it occurs so that health care professionals may take proper actions to prevent it. Methods Retrospective cohort analysis of approx. 300 000 adult admissions in a Danish region was performed. We developed models for UTI prediction with five machine-learning algorithms using demographic information, laboratory results, data on antibiotic treatment, past medical history (ICD10 codes), and clinical data by transformation of unstructured narrative text in Electronic Medical Records to structured data by Natural Language Processing. Results The five machine-learning algorithms have been evaluated by the performance measures average squared error, cumulative lift, and area under the curve (ROC-index). The algorithms had an area under the curve (ROC-index) ranging from 0.82 to 0.84 for the entry model (T = 0 hours after admission) and from 0.71 to 0.77 for the HA-UTI model (T = 48 hours after admission). Conclusion The study is proof of concept that it is possible to create machine-learning models that can serve as early warning systems to predict patients at risk of acquiring urinary tract infections during admission. The entry model and the HA-UTI models perform with a high ROC-index indicating a sufficient sensitivity and specificity, which may make both models instrumental in individualized prevention of UTI in hospitalized patients. The favored machine-learning methodology is Decision Trees to ensure the most transparent results and to increase clinical understanding and implementation of the models.
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Affiliation(s)
- Jens Kjølseth Møller
- Department of Clinical Microbiology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- * E-mail:
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Gyesi-Appiah E, Brown J, Clifton A. Short-term urinary catheters and their risks: an integrated systematic review. Br J Community Nurs 2020; 25:538-544. [PMID: 33161748 DOI: 10.12968/bjcn.2020.25.11.538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This thematic review was part of a bigger literature review into the effects of short-term urinary catheters on patients who are discharged home from an acute hospital. This integrated review examined the risks associated with short-term urinary catheters. The MEDLINE, British Nursing Index and CINAHL databases were searched for studies published between 2013 and 2018 that researched the effects of short-term urinary catheters on patients. Twelve research studies were included, which showed the presence of short-term indwelling urinary catheters increased the risk of infection, length of hospital stay and mortality rates. Short-term urinary catheters should be strictly monitored and removed as soon as they are not required.
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Affiliation(s)
- Evelyn Gyesi-Appiah
- Research Student, De Montfort University, Leicester, and Nurse, University Hospitals of Leicester NHS Trust
| | - Jayne Brown
- Professor of Nursing (Older People), School of Nursing and Midwifery, De Montfort University, Leicester
| | - Andrew Clifton
- Associate Professor, Mental Health Nursing, School of Nursing and Midwifery, De Montfort University, Leicester
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Gyesi-Appiah E, Brown J, Clifton A. Short-term urinary catheters and their risks: an integrated systematic review. ACTA ACUST UNITED AC 2020; 29:S16-S22. [DOI: 10.12968/bjon.2020.29.9.s16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background:This thematic review was part of a bigger literature review into the effects of short-term urinary catheters on patients who are discharged home from an acute hospital.Aims:This integrated review examined the risks associated with short-term urinary catheters.Methods:The MEDLINE, British Nursing Index and CINAHL databases were searched for studies published between 2013 and 2018 that researched the effects of short-term urinary catheters on patients.Findings:Twelve research studies were included, which showed the presence of short-term indwelling urinary catheters increased the risk of infection, length of hospital stay and mortality rates.Conclusion:Short-term urinary catheters should be strictly monitored and removed as soon as they are not required.
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Affiliation(s)
- Evelyn Gyesi-Appiah
- Research Student, De Montfort University, Leicester, and Nurse, University Hospitals of Leicester NHS Trust
| | - Jayne Brown
- Professor of Nursing (Older People), School of Nursing and Midwifery, De Montfort University, Leicester
| | - Andrew Clifton
- Associate Professor, Mental Health Nursing, School of Nursing and Midwifery, De Montfort University, Leicester
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Zhao X, Wang L, Wei N, Zhang J, Ma W, Zhao H, Han X. Risk factors of health care-associated infection in elderly patients: a retrospective cohort study performed at a tertiary hospital in China. BMC Geriatr 2019; 19:193. [PMID: 31324235 PMCID: PMC6642591 DOI: 10.1186/s12877-019-1208-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/10/2019] [Indexed: 12/16/2022] Open
Abstract
Background The elderly inpatients are in high risk of suffering health-care associated infection (HAI). The study aimed to analyze the risk factors of health-care associated infection (HAI) in elderly hospitalized patients to prevent it and improve the recovery rate of elderly patients. Methods The study was a Retrospective Cohort Study based on a 3-year surveillance in elderly inpatients in a large tertiary hospital in China. A retrospective review of the elderly inpatients ≥60 years with or without HAI were conducted. Binary multivariable logistic regression was used to evaluate the potential association between HAI and risk factors. Results We investigated a total of 60,332 subjects aged 60 years old or above. The incidence of HAI in elderly was 2.62%. With adjustment for some factors, advanced age, hospital days before HAI, intensive care unit (ICU) admission, use of ventilator, central line catheter or urinary catheter and cerebral hemorrhage, cerebral infarction, brain neoplasms, diabetes mellitus, coronary artery disease, malignant tumor and malignant hematonosis had significantly increased odds ratios (OR) of suffering from HAI compared with the control group but body weight and operation decreased OR. Conclusion Our findings suggested that advanced age, accompanied by some neurological and chronic noncommunicable diseases, hospital days before HAI, ICU admission, and use of devices were risk factors of suffering HAI in the elderly but the body weight and operation were the potential protective factors in this sample.
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Affiliation(s)
- Xia Zhao
- Hospital Infection Management Division, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Lihong Wang
- Hospital Infection Management Division, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China.
| | - Nan Wei
- School of Health Management and Education, Capital Medical University, Beijing, China
| | - Jingli Zhang
- Hospital Infection Management Division, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Wenhui Ma
- Hospital Infection Management Division, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Huijie Zhao
- Hospital Infection Management Division, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xu Han
- Hospital Infection Management Division, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
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Risk Factors and Prevention Strategies of Nosocomial Infection in Geriatric Patients. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2019; 2019:6417959. [PMID: 30931076 PMCID: PMC6410437 DOI: 10.1155/2019/6417959] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/16/2019] [Accepted: 01/30/2019] [Indexed: 01/04/2023]
Abstract
Introduction To investigate the risk factors of nosocomial infections (NIs) in geriatric department and the effectiveness of the proposed prevention strategy. Methodology We studied 3370 cases of elderly patients who were hospitalized more than 48 hours from January 2015 to December 2017 in the Geriatrics Department of Zhongda Hospital, Southeast University. In order to reduce the infection rate, nutritional risk screening (NRS 2002) was used to evaluate the nutritional status of the patients; enteral nutritional suspension (TPF-FOS) was provided to the patients who were assessed to be necessary. Results Before prevention strategy was taken, the nosocomial infection rate was 3.3% (80 among 2413 patients) in our department. The most frequent NIs were pneumonia (60 cases) followed by urinary tract infection (30 cases). It is worth noting that the elderly patients are often associated with multiple infections: in our study, 15 patients have pneumonia and UTI at the same time. After prevention strategy was taken, the nosocomial infection rate reduced to 1.15% (11 among 957 patients) in our department. Conclusions NIs are common in elderly patients. The improvement of the nutritional status of patients is effective in reducing the risks of NIs.
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