Relations between undernutrition and nosocomial infections in elderly patients
1 Assistance-Publique Hôpitaux de Paris, Hôpital Albert Chenevier, 94010 Creteil Cedex, France
2 Assistance-Publique Hôpitaux de Paris, Hôpital Hôtel-Dieu, 75181 Paris, France.
Address correspondence to: E. Paillaud at Departement de Médecine Interne et Gériatrie, Hôpital Albert Chenevier, AP-HP, 40 rue Mesly, 94010 Creteil Cedex, France. Fax: (+33) 0149 813 810. Email: Elena.Paillaud{at}ach.ap-hop-paris.fr
Background: hospital-acquired infections and malnutrition are of major concern in public health in elderly patients. However, the interactions between these two entities are not well established.
Objectives: to determine the incidence of nosocomial infections (NI) and its association with malnutrition.
Subjects: 185 hospitalised older adults aged 81.6 ± 0.6 years old were nutritionally assessed on admission by measurement of anthropometric variables, serum nutritional proteins and evaluation of dietary intake. During hospitalisation, patients’ progress was closely monitored, particularly for the detection of nosocomial infections.
Results: the incidence rate of NI was 59% and the global infection rate was 7.6/1000 bed days. The most common infection site was the urinary tract (n = 63). The nutritional status of the population was studied by comparing three groups defined according to the absence (group I, n = 116), presence of one infection (group II, n = 38) or presence of more than one infection (group III, n = 31). All but one anthropometric parameters varied among the three groups. Total energy intake also varied among the three groups. The group I had higher daily nutrient intake than the other two groups (respectively P = 0.004 and P < 0.0001). Albumin, transthyretin, and C-reactive protein levels differed significantly among the three groups (respectively P < 0.0001, P < 0.0001 and P = 0.0003). Age, energy intake, length of hospital stay and the presence of a urinary catheter were independent risk factors of nosocomial infection.
Conclusion: our findings show that patients with multiple NI were older, showed an altered nutritional status, a prolonged recovery, more frequently had urinary catheters and more discharge placement.
Keywords: malnutrition, nosocomial infection, elderly
Received June 10, 2005; accepted in revised form August 23, 2005.