Volume 15, Issue 1 (Spring 2020)                   Salmand: Iranian Journal of Ageing 2020, 15(1): 129-118 | Back to browse issues page

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Allahyari E, Keramati M, Kamali M. Predicting Elderly Depression Prevalence in Different Iranian Ethnicities and Associated Factors. Salmand: Iranian Journal of Ageing. 2020; 15 (1) :129-118
URL: http://salmandj.uswr.ac.ir/article-1-1915-en.html
1- Social Determinants of Health Research Center, Faculty of Health, Department of Epidemiology and Biostatistics, Birjand University of Medical Sciences, Birjand, Iran , elaheh.allahyari@gmail.com
2- Department of Public Health, Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
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1. Introduction
nosocomial infection is a type of infection that occurs 48-72 hours after hospitalization, while the patient is not in the incubation period of the infection at the time of admission [1].
More than 20% of nosocomial infections occur in the ICU and cause more than 10%-80% deaths [2]. In the elderly, common and classic forms of infectious diseases are rare and appear more atypical and unusual. In a 2016 study by Mancini, 12 of the 19 people with pseudomonas pneumonia in the ICU were over 70 years old [2].  The incidence of many infectious diseases is higher in the elderly than in other age groups, so that the incidence of respiratory and urinary tract infections in the elderly is 20-50 times higher than in the non-elderly [3]. 
The aim of this study was to investigate the prevalence and risk factors of infections and their complications in the elderly admitted to the ICU of hospitals affiliated to Birjand University of Medical Sciences.

2. Methods & Materials
In this cross-sectional (descriptive-analytical) study, the study population was all elderly patients (over 65 years old) who were admitted to the ICUs of hospitals affiliated to Birjand University of Medical Sciences from April 2015 to March 2016.
ICU of the Valiasr Hospital is an internal ICU, and ICU of the Imam Reza Hospital is a surgical ICU. At the beginning of hospitalization, blood and urine cultures were performed on all patients, and they were cultured with sputum and exudate if they had a sample.
Samples that were initially positive and patients who did not consent to participate in the project or who had taken any antibiotics in the past 72 hours were excluded from the study. The rest of the subjects were sampled again 48-72 hours later. If the test was positive, they remained in the study and those in whom the test result was negative were cultured 48 hours later if they had infection criteria.
Sampling was performed by a trained ICU supervisor under the supervision of an infectious disease specialist. All samples were cultured in a specific medium by a microbiologist. No costs were incurred for patients included in the project and they entered the study with full consent.

Clinical definitions
In this study, an infection was considered a urinary tract infection in which the person had clinical signs of urinary tract infection and the result of his/her culture was positive and the colony count was >105cfu/ml.
Respiratory infection or pneumonia refers to an infection in which a person has a 38-degree fever with cough, purulent sputum, short breaths, pelvic pain, rale sound in the lungs, and a positive radiology for pneumonia. Bacteremia is an infection in which the organism is isolated from blood culture twice without a single site of infection. After collecting data, they were entered into SPSS V. 18 software and analyzed using descriptive statistical tests, frequency percentage and Chi-square analytical test. The code of ethics is IR.bums.REC.1394.17.

3. Results
This study was performed on 417 elderly people over 60 years of age admitted to the ICU of Imam Reza and Valiasr hospitals in Birjand with a mean age of 74.04±8.9 years, a minimum age of 60 years, and a maximum age of 99 years. A total of 255 patients (61.2%) were admitted to the ICU of Imam Reza Hospital and the rest were admitted to the ICU of Valiasr Hospital. Also, a total of 191 patients (45.8%) were male and the rest were female.
The prevalence of infection in the studied patients was 18.7% (78 patients). The prevalence of infection in males was significantly higher than females (P=0.01), and the prevalence of infection increased significantly with increasing duration of ICU hospitalization (P<0/001) (Table 1).


The most common infection in the elderly was respiratory infection (53.8%) and then urinary tract infection. Chi-square test showed that there was no significant statistical difference in the type of infection by age and sex. The prevalence of infection was higher in the elderly over 75 years of age than in people aged 74-60 years, but this difference was not statistically significant. Also, the prevalence of infection in the ICU of Valiasr Hospital was significantly higher than the ICU of Imam Reza Hospital (P<0.001) (Table 2).

Out of 417 patients studied, 98 people (23.5%) died. In patients with positive infection, 30.8% of 78 people, and in patients with negative infection, 21.8% of 339 people died. This difference was not statistically significant using Chi-square test (P=0.09) (Table 3).

In our study, the rate of infection was significantly related to the duration of hospitalization and male gender (Table 1), so that patients with a duration of hospitalization of more than 10 days had 67.3% infection.
The most common infections in our study were respiratory infections (53.8%) and then urinary tract infections (43.1%), followed by wound infection and bacteremia (25.5% and 21.4%), respectively.
In this study, in terms of pathogenic symptoms, the most common organisms were: Pseudomonas for respiratory infection; E.coli and Pseudomonas and Candida for urinary tract infections; and Staphylococcus aureus and Pseudomonas for wound infection and bacteremia. Also, according to the present study, the prevalence of infections in the ICU of Valiasr Hospital, which is an internal ICU, was significantly higher than the ICU of Imam Reza Hospital, which is a surgical ICU.
In terms of mortality, in our study, although there was no significant relationship between infection and mortality, but quite clearly in people with positive infection mortality was 30.8% more than people without infection (21.8%).
4. Conclusion
In this study, the prevalence of infection was 18.7%. In the above-mentioned ICUs, the infection rate in the elderly was 10.8%.
Various studies have shown that nosocomial infections in the ICUs are 5%-15% more than other wards, which can increase to 50%. This may be due to the fact that the clinical signs of infections in the elderly are not typical and this in turn delays in diagnosis and therefore in treatment.
In this study, the rate of infection was significantly related to the duration of hospitalization and male gender (Table 1), so that patients with a length of hospital stay of more than 10 days had 67.3% infection. In the 2014 Solis study, the rate of infection in the ICU was directly related to the length of hospital stay [1].
According to the present study and most studies, the high prevalence of respiratory infections is due to long-term intubations required in the ICU. Therefore, if the elderly are hospitalized in the ICU, it is better to reduce the length of their stay to a minimum.

Ethical Considerations
Compliance with ethical guidelines

This cross sectional study was approved by the ethics committee of Birjand University  of Medical Science (Code: IR.BUMS.REC.1395.107).
This study was extracted from a research proposal and received financial support from the Deputy for Research And Technology of Birjand University of Medical Science.
Authors' contributions
Conceptualization, Investigation: Azadeh Ebrahimzadeh, Majid Zare Bidaki; Methodology: Gholamreza Sharifzadeh; Writing–original draft: Zohreh Azarkar, Majid Zare bidaki; Writing–review & editing: Majid Zare; Supervision: Azadeh Ebrahimzadeh.
Conflicts of interest
The authors declared no conflict of interest.
The authors would like to appreciate the ICU supervisors and microbiologists of Vali-e Asr and Emam Reza Hospitals. 

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Type of Study: Research | Subject: Psychology
Received: 2019/10/09 | Accepted: 2019/12/08 | Published: 2018/12/31

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