TY - JOUR
T1 - Risk factors for functional decline among survivors of Gram-negative bloodstream infection
T2 - A prospective cohort study
AU - Turjeman, Adi
AU - Koppel, Fidi
AU - Franceschini, Erica
AU - Yahav, Dafna
AU - Dolci, Giovanni
AU - Babich, Tanya
AU - Bitterman, Roni
AU - Neuberger, Ami
AU - Ghanem-Zoubi, Nesrin
AU - Santoro, Antonella
AU - Eliakim-Raz, Noa
AU - Pertzov, Barak
AU - Stern, Anat
AU - Dickstein, Yaakov
AU - Maroun, Elias
AU - Zayyad, Hiba
AU - Meschiari, Marianna
AU - Bishara, Jihad
AU - Goldberg, Elad
AU - Venturelli, Claudia
AU - Mussini, Cristina
AU - Paul, Mical
AU - Leibovici, Leonard
N1 - Publisher Copyright:
© 2021 Turjeman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2021/11
Y1 - 2021/11
N2 - Objective To identify risk factors for functional decline after hospitalization for Gram-negative bacteremia. Patients and methods 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. Results 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 oneyear 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). Conclusions 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.
AB - Objective To identify risk factors for functional decline after hospitalization for Gram-negative bacteremia. Patients and methods 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. Results 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 oneyear 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). Conclusions 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.
UR - http://www.scopus.com/inward/record.url?scp=85119687115&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0259707
DO - 10.1371/journal.pone.0259707
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C2 - 34788325
AN - SCOPUS:85119687115
SN - 1932-6203
VL - 16
JO - PLoS ONE
JF - PLoS ONE
IS - 11 November
M1 - e0259707
ER -
