Function and Infection Prevention ? Prof. Gatan Gavazzi GREPI - - PowerPoint PPT Presentation

Function and Infection Prevention ?

• Prof. Gaëtan Gavazzi

GREPI EA7408 University of Grenoble-Alpes Clinc of Geriatric Medicine University hospital of Grenoble-Alpes

CONFLICT OF INTEREST DISCLOSURE

I have no potential conflict of interest to report

• …

Concept de Fragilité If Ageing is Universal, Intrinseque, Progressive and somehow Deleterious

Ageing is

HETEROGENEOUS

80% OF >80 Y POP. AT HOME WITHOUT ADL DISABILITY

Genetic Epigenetic Environment (comorbidites)

Micro-organisms More abondant / mammals Same species / HETEROGENEITE

> than 1029 species ???

Genetic and Epigenetic factors Environment

Host-pathogen interaction and its evolution / Colon Microbiota ? Epigenetic, Bio-Age ? Impact of antibiotic?

The classical view of functional ….the decline in ageing population

Herpes zoster consortium Gavazzi G Aging Clin Exp Res 2016

The older persons One trigger = several complications

Numerous unexpected complications

Iatrogenic events, Health care Associated Infection Falls Malnutrition Immobilisation / pressure sores Delirium /behavioural disorders Complications of Chronic Diseases

( known or unknown)

Disability

 in hospital length of stay and  cost

infection and functional status relationship ? Infection as a risk factor for funcional decline/ functional status as a risk factor for infection or severity Prevention of Infection to prevent disability ? Prevention of disability to prevent infection ?

Outline

Influenza and functional decline

William H. Barker Arch Intern Med 1998

Grenoble 2013 : flu outbreak: 29 cases Out of 220 admissions, 20 were nosocomial Functional decline in chez 66,6% patients (loss of > 1 ADLpoint), Median Functional decline : from 4.5 to 3.2

Drevet S 2017 (in preparation)

Gozalo JAGS 2013

Impact of infection on Functional status

Torres Sharma Binder Bula JAGS 2003 Infec Dis clin Pract J Gerontol 2003 JAGS 2005

CAP/ NHAP and functional decline

CAP NHAP n 99 79 781 1070 Functional decline 23% 29% 28.8 % 31.1% Date of Evaluation (d) 15 180 30-90 180 Risk Factors PSI no Multiples

2006

Motor dysfunction

Mc Elhaney Eur Ger Med 2016 *Schmader K JAGS 2010

Zoster and functional decline ? ZBPI interference score on ADL burden

Impact of herpes zoster pain on health-related quality of life and functioning : risk of loss of autonomy

Schmader CID (2001).

Psychological impact

Depression Anxiety Difficulty concentrating

Social impact

Decreased social gatherings Change in social role

Functional impact

Interfere with basic and instrumental activities of daily living:

• Dressing, bathing,

eating, mobility,

• Ttravelling, cooking,

housework, shopping

Physical impact

Chronic fatigue Anorexia Weight loss, Physical inactivity Insomnia

Greater pain burden, associated with poorer physical functioning, increased emotional distress, and decreased role and social functioning HZ-related pain The magnitude of suffering is directly related to pain intensity & duration

Zoster : does it Harm ?

1 out of 4/5 individual will experiment Zoster over his life

> 50% >60 years

> 80 y 10-20% With Post Herpectic Neuralgia

Adjusted for age, history of smoking, BMI 25 kg/m2, diabetes mellitus, CHF, Caucasian race, and high school education; race and education used as markers for socioeconomic status (SES)

CMV Infection With inflammation response and Frailty phenotype ?

Schmaltz HN JAGS 2005

infection and functional status relation ship ? Infection as a risk factor for funcional decline/ Functional status as a risk factor for infection or severity Prevention of Infection to prevent disability ? Prevention of disability to prevent infection ?

• utline

Facteurs de risque de pneumonie

Jackson ML et al. J Am Geriatr Soc. 2009;57(5):882-8.

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Functional status As a risk factor for Pneumonia ?

Jackson JAGS 2009

Diasability as a risk factor according age

Functional Status and infection

FS as a risk factor

Loeb M Arch Intern Med 1999

(prospective study, 85 y, 254 à 79 patients 3y )

Respiratory tract infection in « Nursing home »

•  Functional status =  incidence x 2.6(1.8-3.8)

prospective study, Infections in « Nursing home »

3 level of ADL, 85 y, 1070 patients 6 month follow up Bula JAGS 2005

Case-control, Surgical site

Infections due to MRSA 2 levels of ADL, 73 y, 253 patients

Functional Status and infection

FS as a risk factor

Marchaim D AAC 2011

ESBL Escherichia coli Bacteriemia

MDR Colonisations risk factors

Maziere S, Gavazzi G, JNHA 2013

Nosocomial infection level of ADL, 85 y, 214 patients  Functional status =  prevalence NI

Non adjusted Adjusted OR (CI 95 %) p OR (CI 95 %) p Urinary tract indwelling ADL<3 at admission New functional decline Pressure sore Pneumonia Life threatening diagnosis 5,8 (2,5-13,9) 6,5 (2,4-17,3) 2,3 (1,1-4,7) 3,3 (1,4-7,7) 3,3 (1,6-7,2) 3,1 (1,3-7,1) <0,01 <0,01 0,02 <0,01 <0,01 <0,01 4,4 (1,6-12,3) 4,4 (1,8-11,1)

• 2,7 (1,1-6,6)

<0,01 <0,01

• 0,03

Independant from recent surgery, ATBic consumption, catheter…

Functional Status and infection

FS as a risk factor

Functional status is a prognosis factor for death associated Nosocomial bacteremia

Gavazzi G Aging Clin Exper Res 2004,

Nosocomial bacteremia level of ADL, 85 y, 62 patients  Functional status =  30d-Mortality

Endocarditis in older?

Incidence Peak > 70 ans 194/million/an Mortality >65 ans 16 à 45 % Clinic : Atypical Presentation Microbiology S aureus et Streptococcus sp Anatomic more prothesis TAVI….

Selton-Suty Clin Infect Dis 2012,, Forestier E Clin interv Aging 2015

Elderl-IE multicentre study (Cardio / infectio / Geriatrician) ,

France ( GinGer)

IAS 24(22%) Germs : Strepto D et Enteroc65(55%)

• S. aureus 32 (27%)

n= 120, 83±5 ans, 53% male Charlson 1,8±1,7, CIRS-G 15±8, 7 pills /d

Selton, Roubaud, Forestier en preparation

Endocarditis in older?

Prognosis

• A 3 month-mortality rate of 28.4%

Motif pas de chir EG altéré Grabataire Démence Comorbidités Etat cardiaque Refus famille

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7 2 7 5 2

• Complication

pdt hospit Escarre Chute Contention

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(12.9) 12 (10.5) 9 (8.1)

• Factors associated with survival

ADL at day 0 MMSE à J0

Functional Trajectory ADL et IADL (n=57)

Selton, Roubaud, Forestier en preparation

Loss in ADL Part of recovery Loss in IADL No recovery Long term impact

infection and functional status relation ship ? Infection as a risk factor for funcional decline/ Functional status as a risk factor for infection or severity Prevention of Infection to prevent disability ? Prevention of disability to prevent infection ?

• utline

Levin MJ , Current op Immunol 2012, *Schmader K JAGS 2010

Age-related efficacy response to 1st live- attenuated VZV vaccine

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Real decrease efficacy to reduce shingles incidence after 80 years old Still a large efficay regarding, PHN and impact on activity incidence incidence

infection and functional status relation ship ? Infection as a risk factor for funcional decline/ Functional status as a risk factor for infection or severity Prevention of Infection to prevent disability ? Prevention of disability to prevent infection ? No study

Outline

Take Home Messages

Functional status act as strong risk factor / prognosis in many infections Flu /Pneumonia / bacteremia act as triggers for Functional decline

Some strategies (vaccine) may decrease functional decline (few studies) But NO study to test if prevention of functional decline may prevent infection

Thank you for your attention

Still a long way……

“The good physician treats the disease; the great physician treats the patient who has the disease.” William Osler

Massif de Belledone, France

Invitation to : EUGMS Study Interest Group on Infection and vaccine ggavazzi@chu-grenoble.fr