Infections common in patients who fall

Issue: November 2015

SAN DIEGO — Urinary tract infections, bacteremia, lower respiratory tract infections and other systemic infections may be common among patients admitted to health care facilities due to a fall, according to data recently presented at IDWeek 2015.

“The coexistence of infection can exist with the fall, and the fall may just be an atypical manifestation of a potentially serious infection,” Farrin A. Manian, MD, MPH, of Massachusetts General Hospital, said during a press event. “Both the public as well as the health care workers need to recognize that so that perhaps we can identify the infection sooner and treat it earlier so that hopefully we can improve prognosis of the patient.”

Farrin A. Manian

Manian and Alexander J. Blair, MS, a student at Harvard Medical School, performed a retrospective analysis of 161 adult patients admitted to their institution from 2000 to 2014. Eligible patients were those whose chief complaint was related to a recent fall, but were subsequently diagnosed with a coexisting systemic infection (CSI) within 48 hours of presentation. Relevant patient information was retrieved from the hospital’s data registry using related search terms, such as “accidental fall” or “systemic inflammatory response syndrome.”

The mean age of the cohort was 76 years, but it included patients who were aged from 35 years to 102 years. Approximately 78% of these patients lived at home, and 52.8% were women. Fracture complications were present in 18.6% of the cohort, and 32.9% reported one or more symptoms before falling. In-hospital mortality occurred in 18% of examined cases.

UTIs were detected among 44.1% of patients, bacteremia among 39.8%, lower respiratory tract infection among 23%, and sepsis due to an unidentified source among 21.1%. Blood culture after diagnosis of bacteremia most frequently detected Staphylococcus aureus and Escherichia coli. CSI was not initially suspected by the providing physician in 39.8% of cases, and was not suspected to be a contributing factor to the fall among 76.4% of cases.

These data provide preliminary evidence that practitioners examining patients presenting with a fall should consider CSI as a potential factor during routine evaluation, Manian said.

“I honestly look at this as a very first step in trying to establish that there is an association,” Manian said. “The second step would be to really look at it in other institutions, do a multicenter type of study with a broader range of patients so you can have a better characterization of these patients.” – by Dave Muoio

Reference:

Blair AJ, et al. Abstract 813. Presented at: IDWeek; Oct. 7-11, 2015; San Diego.

Disclosure: The researchers report no relevant financial disclosures.