Elderly patients with healthcare-associated infections in the emergency department: clinical characteristics and risk factors for septic shock: a retrospective study.

BACKGROUND/

aimIn emergency departments (EDs), it is difficult to diagnose infections and sepsis in elderly patients because the symptoms of infection present atypically. This can lead to especially healthcare-associated infections caused by resistant microorganisms being missed, delays in treatment, and poor outcomes.

methodsThis retrospective surveillance study was conducted at Kayseri City Training and Research Hospital. Patients who admitted the ED during the specified period, were evaluated by the Infectious Diseases and Clinical Microbiology Clinic, and were diagnosed with an infection were included in the study. Patients were divided into two groups based on age elderly and non-elderly. Demographic data, comorbidities, infection sources, SOFA scores, and microbiological agents were recorded.

resultsA total of 4,095 patients presented to theED during the study period. Of these, 1,100 patients were diagnosed with infection, and 800 patients were included in the study. overall, 520 (65%) were elderly, and 280 (35%) were non-elderly; 50.9% of patients were male, and the mean age was 68.2 ± 14.6 years. Hypertension (p < 0.001), diabetes (p = 0.002), coronary artery disease (p = 0.007), Chronic obstructive pulmonary disease (p = 0.001), congestive heart failure (p = < 0.001), and cerebrovascular event (p = 0.027) were significantly more common in elderly patients compared to non-elderly patients. Malignancy was more common in the non-elderly group (p = 0.022). On admission, the incidence of sepsis was similar between groups (p = 0.070), septic shock was significantly more common in elderly patients (p = 0.009). Additionally, SOFA scores were higher in the elderly group (5.2 ± 2.3 vs. 4.9 ± 2.3, p = 0.023 ). Urinary catheters (p < 0.001), central venous catheters (p < 0.001), and stay in intensive care unit (p = 0.022) were more common in elderly than non-elderly patients within the last 90 days. In the subgroup of the elderly patients, urinary catheterization (OR:26.076, p:<0.001), central venous catheterization (OR:6.756, p = 0.013), and mechanical ventilation (OR:12.064, p < 0.001) in last 90-day were identified as independent risk factors for septic shock in the multivariate analysis. Escherichia coli and Staphylococcus aureus were the most frequently isolated bacteria in blood cultures (n = 26 and n = 26). Extended Spectrum Beta Lactamases (54.2% vs. (18.2%) rate were higher in the elderly group (p = 0.0.48). 90% of S. aureus isolates in the elderly group were methicillin-resistant. This rate was 50% in the non-elderely group (p = 0.032).

conclusionHealthcare-associated infections in elderly patients are associated with an increased risk of septic shock. This is independently associated with the use of invasive devices, particularly urinary catheters, central venous catheters and mechanical ventilation, within the previous 90 days. Furthermore, the higher prevalence of multidrug-resistant pathogens, including ESBL-producing Enterobacterales and MRSA, further complicates treatment in this population. These findings highlight the importance of emergency medicine physicians systematically assessing recent healthcare exposure and the history of invasive device use in elderly patients, and initiating early, targeted empirical antimicrobial therapy that covers resistant organisms.