Risk factors for functional decline among survivors of Gram-negative bloodstream infection: A prospective cohort study

Risk factors for functional decline among survivors of Gram-negative bloodstream infection: A prospective cohort study

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<h4>Objective</h4> To identify risk factors for functional decline after hospitalization for Gram-negative bacteremia. <h4>Patients and methods</h4> A prospective cohort study based on a randomized controlled trial conducted between January 1, 2013 and August 31, 2017 in Isra...

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Autores principales: Adi Turjeman, Fidi Koppel, Erica Franceschini, Dafna Yahav, Giovanni Dolci, Tanya Babich, Roni Bitterman, Ami Neuberger, Nesrin Ghanem-Zoubi, Antonella Santoro, Noa Eliakim-Raz, Barak Pertzov, Anat Stern, Yaakov Dickstein, Elias Maroun, Hiba Zayyad, Marianna Meschiari, Jihad Bishara, Elad Goldberg, Claudia Venturelli, Cristina Mussini, Mical Paul, Leonard Leibovici
Formato: article
Lenguaje:EN
Publicado: Public Library of Science (PLoS) 2021
Materias:
Medicine
R
Science
Q
Acceso en línea:https://doaj.org/article/440b5ede23b64ade98cd8c51c449aea8
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Sumario:<h4>Objective</h4> To identify risk factors for functional decline after hospitalization for Gram-negative bacteremia. <h4>Patients and methods</h4> A prospective cohort study based on a randomized controlled trial conducted between January 1, 2013 and August 31, 2017 in Israel and Italy. Hospitalized patients with Gram-negative bacteremia who survived until day 90 and were not bedridden at baseline were included. The primary end point was functional decline at 90 days. <h4>Results</h4> Five hundred and nine patients were included. The median age of the cohort was 71 years (interquartile range [IQR], 60–80 years), 46.4% (236/509) were male and 352 of 509 (69%) patients were independent at baseline. Functional decline at 90 days occurred in 24.4% of patients (124/509). In multivariable analysis; older age (odds ratio [OR], 1.03; for an one-year increment, 95% confidence interval [CI] 1.01–1.05), functional dependence in instrumental activities of daily living at baseline (OR, 4.64; 95% CI 2.5–8.6), low Norton score (OR, 0.87; 95% CI 0.79–0.96) and underlying comorbidities: cancer (OR, 2.01; 95% CI 1.14–3.55) and chronic pulmonary disease (OR, 2.23 95% CI 1.12–4.42) and longer length of hospital stay (OR 1.09; for one-day increment, 95% CI 1.04–1.15) were associated with functional decline. Appropriate empirical antibiotic treatment was associated with lower rates of functional decline within 90 days (OR, 0.4; 95% CI 0.21–0.78). <h4>Conclusions</h4> Patients surviving bloodstream infections have poor long term trajectories after clinical recovery and hospital discharge. This has vast implications for patients, their family members and health policy makers.

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