Abstract
BackgroundElderly patients who experience hip fractures often become bedridden and are at risk of developing lower respiratory tract infections. The current study was to investigate the etiology and bacterial drug resistance patterns of elderly patients with hip fractures and lower respiratory tract infections on prolonged bedridden time and to determine their prognosis.MethodsPatients diagnosed with hip fractures admitted from May 2015 to April 2017 were included. The basic characteristics including the patients’ gender, age, fracture type, operation mode, bedridden duration, length of hospital stay, prognosis, past medical history, routine bloodwork, C-reactive protein (CRP), procalcitonin (PCT), blood biochemistry, blood gas analysis, glycosylated hemoglobin (HbA1C%), sputum smear, sputum culture, and anti-infection and related therapy were recorded. All patients were classified into three groups based on bed rest duration, including short-term (<1 month), mid-term (1–12 months), and long-term (> 12 months). The correlation between the bedridden time and the patients’ basic characteristics, disease history, laboratory examination results, pathogen, anti-infection, and related therapy were evaluated. The risk factors related to the prognosis of the disease were investigated.ResultsProlonged bed rest in patients led to an increase in hospitalization time, mortality rates, and decreased serum albumin levels (P < 0.05). Sputum bacteriological culture results showed that, with bed rest prolongation, the proportion of Pseudomonas aeruginosa and fungal infections increased. Binomial logistic regression of pulmonary infection prognosis, glucocorticoid use during the anti-infective period, prolonged bedridden time, and serum albumin level showed that intravenous use of glucocorticoid during anti-infective treatment, bed rest > 1 year, and low serum albumin level were related to poor prognosis.ConclusionElderly hip fracture patients with prolonged bedridden time had an increased chance of opportunistic pulmonary infection and decreased nutritional status. Glucocorticoids should be used cautiously.
Highlights
Patients who experience hip fractures often become bedridden and are at risk of developing lower respiratory tract infections
The inclusion criteria were (1) age (≥ 65 years old); (2) acute hip fracture diagnosed by an imaging examination or patients had a clear history of hip fracture, which subsequently led to the limitation or loss of the patients' abilities to live independently or move freely; (3) lower respiratory tract infection met the criterion of Chinese diagnosis and treatment of communityacquired pneumonia in adults (2016) [15], including infection of the pulmonary parenchyma, community-acquired pneumonia, and pneumonia caused by a latent pathogenic infection in the period following admission; (4) blood tests, sputum specimens, and chest imaging examination completed within 72 h of admission; and (5) complete medical records and laboratory examinations
Basic characteristics A total of 101 elderly bedridden patients with hip fractures and lower respiratory tract infections were enrolled in the study, including 46 cases in the short-term bedridden group (45.5%), 23 cases in the medium-term bedridden group (22.8%), and 32 cases in the long-term bedridden group (31.7%)
Summary
Patients who experience hip fractures often become bedridden and are at risk of developing lower respiratory tract infections. Approximately 6.9–17% of elderly patients with hip fractures died within 30 days after surgery [9, 10]. The extent to which a lower respiratory tract infection would affect the development of disease in elderly patients with hip fractures has been investigated. Several studies have shown that lower respiratory tract infection is the primary cause of perioperative death in elderly patients with hip fractures and the primary cause of 30 days re-admission after surgery and the main cause of high mortality at 30 days after surgery [7, 11,12,13]. It has been shown that the high mortality of hip fracture lasts for 1 year after injury [7, 13], while another study has found that the high mortality may continue for more than 20 years after injury [14]
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