The factors associated with nosocomial infection in elderly hip fracture patients: gender, age, and comorbidity

Abstract

Purpose This is a retrospective case–control study to ascertain the factors influencing nosocomial infection (NI) in elderly patients with hip fractures. Methods A total of 80,174 patients (≥ 60 years) who suffered hip fractures between 2006 and 2017 were identified through a national inquiry of 94 hospitals. The patients were divided into an NI group and control group according to the occurrence or lack of occurrence of NI within 48 hours after surgery, respectively. Age, gender, hip fracture pattern, whether to operate, surgical treatments, and comorbidities were recorded as variables. Results A total of 9806 elderly hip fracture patients (60 years) were included, 1977 of whom were patients diagnosed with NI. The control group consisted of randomly drawn cases from the 9806 patients from different hospitals with a rate of one NI patient: four patients without NI. Patient gender, age, and in particular the number of comorbidities were associated with occurrence of NI. Using regression models to predict infection outcomes based on the number of comorbidities had an area under the curve (AUC) of 0.714, while using the Charlson comorbidity index (CCI) yielded a smaller value of 0.694. The most common comorbidities of this elderly cohort were chronic respiratory disease, hypertension, diabetes mellitus, cerebrovascular disease, and coronary heart disease. Conclusions Older age, male gender, and greater number of comorbidities were found to be associated with the occurrence of NI. In particular, the number of comorbidities was the most accurate predictor of NI occurrence, and when used to build a regression model, it had greater predictive capability than CCI to predict NI in elderly hip fracture patients. Additionally, the common diseases of the elderly should be primarily considered when investigating the relationship between comorbidities and NI in older patients.

Risk factors and outcomes of healthcare-associated infections in a Brazilian intensive care unit: A cross-sectional study

“…Age emerged as a prognostic determinant: the concentration of deaths among those aged 60–79 years and the higher odds of discharge among those aged 20–39 and 40–59 years mirror previously described trends in which aging, multimorbidity, and immunosenescence increase susceptibility and severity (Deng et al, 2021 ; Muirhead et al, 2022 ; Ribeiro et al, 2023 ). The age gradient observed aligns with international and national studies linking advanced age to higher HAI risk and worse outcomes (Li et al, 2023 ), reinforcing the need for streamlined geriatric assessment routines and frailty management in the ICU.…”

Risk factors and outcomes of healthcare-associated infections in a Brazilian intensive care unit: A cross-sectional study

“…Age emerged as a prognostic determinant: the concentration of deaths among those aged 60–79 years and the higher odds of discharge among those aged 20–39 and 40–59 years mirror previously described trends in which aging, multimorbidity, and immunosenescence increase susceptibility and severity (Deng et al, 2021 ; Muirhead et al, 2022 ; Ribeiro et al, 2023 ). The age gradient observed aligns with international and national studies linking advanced age to higher HAI risk and worse outcomes (Li et al, 2023 ), reinforcing the need for streamlined geriatric assessment routines and frailty management in the ICU.…”

Risk factors for hospital-acquired pneumonia in hip fracture patients: A systematic review and meta-analysis [RETRACTED]

“…The remaining 2 studies [ 6 , 18 ] reported the relationship between advanced age (stratification variable) and HAP, and there was minor heterogeneity among the studies (Fig. 3 C–E; Table 3 ).…”

“…This was related to the decline in the functions of various organs caused by aging. [6,[18][19][20]24,28] After the elderly hip fracture was bedridden, the tracheobronchial ciliary movement function weakened, the cough reflex worsened, the elasticity of lung tissue decreased, and the immunity of the elderly was weak, so pulmonary infection was easy to occur under long-term immobilization. [4,21,[44][45][46] In the actual situation, advanced age as a single indicator to predict pneumonia is too single, and we should combine age with other factors for comprehensive analysis.…”

Risk factors for hospital-acquired pneumonia in hip fracture patients: a systematic review and meta-analysis

“…Compared with other age groups, the probability of pneumonia occurring over 90 years old was increased considerably. This was related to the decline in the functions of various organs caused by aging [ 6 , 18 – 20 , 24 , 28 ]. After the elderly hip fracture was bedridden, the tracheobronchial ciliary movement function weakened, the cough reflex worsened, the elasticity of lung tissue decreased, and the immunity of the elderly was weak, so pulmonary infection was easy to occur under long-term immobilization [ 4 , 21 , 44 – 46 ].…”

“…After the elderly hip fracture was bedridden, the tracheobronchial ciliary movement function weakened, the cough reflex worsened, the elasticity of lung tissue decreased, and the immunity of the elderly was weak, so pulmonary infection was easy to occur under long-term immobilization [4,21,[44][45][46]. In the actual situation, advanced age as a single indicator to predict pneumonia is too single, and we should combine age with other factors for comprehensive analysis [18,22,29,30]. Another critical factor was gender.…”

Risk factors and outcomes of healthcare-associated infections in a Brazilian intensive care unit: A cross-sectional study

“…Age emerged as a prognostic determinant: the concentration of deaths among those aged 60–79 years and the higher odds of discharge among those aged 20–39 and 40–59 years mirror previously described trends in which aging, multimorbidity, and immunosenescence increase susceptibility and severity (Deng et al, 2021 ; Muirhead et al, 2022 ; Ribeiro et al, 2023 ). The age gradient observed aligns with international and national studies linking advanced age to higher HAI risk and worse outcomes (Li et al, 2023 ), reinforcing the need for streamlined geriatric assessment routines and frailty management in the ICU.…”

Risk factors for hospital-acquired pneumonia in hip fracture patients: A systematic review and meta-analysis [RETRACTED]

“…The remaining 2 studies [ 6 , 18 ] reported the relationship between advanced age (stratification variable) and HAP, and there was minor heterogeneity among the studies (Fig. 3 C–E; Table 3 ).…”

“…This was related to the decline in the functions of various organs caused by aging. [6,[18][19][20]24,28] After the elderly hip fracture was bedridden, the tracheobronchial ciliary movement function weakened, the cough reflex worsened, the elasticity of lung tissue decreased, and the immunity of the elderly was weak, so pulmonary infection was easy to occur under long-term immobilization. [4,21,[44][45][46] In the actual situation, advanced age as a single indicator to predict pneumonia is too single, and we should combine age with other factors for comprehensive analysis.…”

Risk factors for hospital-acquired pneumonia in hip fracture patients: a systematic review and meta-analysis

“…Compared with other age groups, the probability of pneumonia occurring over 90 years old was increased considerably. This was related to the decline in the functions of various organs caused by aging [ 6 , 18 – 20 , 24 , 28 ]. After the elderly hip fracture was bedridden, the tracheobronchial ciliary movement function weakened, the cough reflex worsened, the elasticity of lung tissue decreased, and the immunity of the elderly was weak, so pulmonary infection was easy to occur under long-term immobilization [ 4 , 21 , 44 – 46 ].…”

“…After the elderly hip fracture was bedridden, the tracheobronchial ciliary movement function weakened, the cough reflex worsened, the elasticity of lung tissue decreased, and the immunity of the elderly was weak, so pulmonary infection was easy to occur under long-term immobilization [4,21,[44][45][46]. In the actual situation, advanced age as a single indicator to predict pneumonia is too single, and we should combine age with other factors for comprehensive analysis [18,22,29,30]. Another critical factor was gender.…”

Risk factors and outcomes of healthcare-associated infections in a Brazilian intensive care unit: A cross-sectional study

“…Age emerged as a prognostic determinant: the concentration of deaths among those aged 60–79 years and the higher odds of discharge among those aged 20–39 and 40–59 years mirror previously described trends in which aging, multimorbidity, and immunosenescence increase susceptibility and severity (Deng et al, 2021 ; Muirhead et al, 2022 ; Ribeiro et al, 2023 ). The age gradient observed aligns with international and national studies linking advanced age to higher HAI risk and worse outcomes (Li et al, 2023 ), reinforcing the need for streamlined geriatric assessment routines and frailty management in the ICU.…”

Risk factors for hospital-acquired pneumonia in hip fracture patients: A systematic review and meta-analysis [RETRACTED]

“…The remaining 2 studies [ 6 , 18 ] reported the relationship between advanced age (stratification variable) and HAP, and there was minor heterogeneity among the studies (Fig. 3 C–E; Table 3 ).…”

“…This was related to the decline in the functions of various organs caused by aging. [6,[18][19][20]24,28] After the elderly hip fracture was bedridden, the tracheobronchial ciliary movement function weakened, the cough reflex worsened, the elasticity of lung tissue decreased, and the immunity of the elderly was weak, so pulmonary infection was easy to occur under long-term immobilization. [4,21,[44][45][46] In the actual situation, advanced age as a single indicator to predict pneumonia is too single, and we should combine age with other factors for comprehensive analysis.…”

Risk factors for hospital-acquired pneumonia in hip fracture patients: a systematic review and meta-analysis

“…Compared with other age groups, the probability of pneumonia occurring over 90 years old was increased considerably. This was related to the decline in the functions of various organs caused by aging [ 6 , 18 – 20 , 24 , 28 ]. After the elderly hip fracture was bedridden, the tracheobronchial ciliary movement function weakened, the cough reflex worsened, the elasticity of lung tissue decreased, and the immunity of the elderly was weak, so pulmonary infection was easy to occur under long-term immobilization [ 4 , 21 , 44 – 46 ].…”

“…After the elderly hip fracture was bedridden, the tracheobronchial ciliary movement function weakened, the cough reflex worsened, the elasticity of lung tissue decreased, and the immunity of the elderly was weak, so pulmonary infection was easy to occur under long-term immobilization [4,21,[44][45][46]. In the actual situation, advanced age as a single indicator to predict pneumonia is too single, and we should combine age with other factors for comprehensive analysis [18,22,29,30]. Another critical factor was gender.…”