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

<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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spelling	oai:doaj.org-article:440b5ede23b64ade98cd8c51c449aea82021-11-25T06:19:47ZRisk factors for functional decline among survivors of Gram-negative bloodstream infection: A prospective cohort study1932-6203https://doaj.org/article/440b5ede23b64ade98cd8c51c449aea82021-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8598031/?tool=EBIhttps://doaj.org/toc/1932-6203<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.Adi TurjemanFidi KoppelErica FranceschiniDafna YahavGiovanni DolciTanya BabichRoni BittermanAmi NeubergerNesrin Ghanem-ZoubiAntonella SantoroNoa Eliakim-RazBarak PertzovAnat SternYaakov DicksteinElias MarounHiba ZayyadMarianna MeschiariJihad BisharaElad GoldbergClaudia VenturelliCristina MussiniMical PaulLeonard LeiboviciPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q 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 Risk factors for functional decline among survivors of Gram-negative bloodstream infection: A prospective cohort study
description	<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.
format	article
author	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
author_facet	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
author_sort	Adi Turjeman
title	Risk factors for functional decline among survivors of Gram-negative bloodstream infection: A prospective cohort study
title_short	Risk factors for functional decline among survivors of Gram-negative bloodstream infection: A prospective cohort study
title_full	Risk factors for functional decline among survivors of Gram-negative bloodstream infection: A prospective cohort study
title_fullStr	Risk factors for functional decline among survivors of Gram-negative bloodstream infection: A prospective cohort study
title_full_unstemmed	Risk factors for functional decline among survivors of Gram-negative bloodstream infection: A prospective cohort study
title_sort	risk factors for functional decline among survivors of gram-negative bloodstream infection: a prospective cohort study
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/440b5ede23b64ade98cd8c51c449aea8
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Risk factors for functional decline among survivors of Gram-negative bloodstream infection: A prospective cohort study

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