Infection on Frail Patients in the Intensive Care Unit: Insights From the PalMuSIC Study

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Geriatrics

Background:

• Frailty is increasingly prevalent in intensive care units (ICUs).
• The impact of frailty on infection incidence, multidrug-resistant (MDR) microorganisms, and broad-spectrum antibiotic efficacy in ICUs is understudied.

Purpose of the Study:

• To investigate the association between frailty and infection incidence in ICU patients.
• To determine the risk of MDR microorganisms in frail versus non-frail ICU patients.
• To evaluate the impact of broad-spectrum antibiotics on mortality in frail ICU patients.

Main Methods:

• A multicentric, prospective, observational study involving 335 adult patients across 23 Portuguese ICUs.
• Frailty was assessed using the Clinical Frailty Score (CFS), with patients defined as frail if their mean CFS was ≥5.
• Data collected included infection status, causative microorganisms (including MDR), and antibiotic use (carbapenems).

Main Results:

• Frailty was diagnosed in 20.9% of patients.
• Infection rates were similar between frail (35.7%) and non-frail (28.3%) patients.
• MDR microorganisms were significantly more common in frail patients (OR: 2.65, p=0.018).
• Broad-spectrum antibiotic use (carbapenems) showed no clear mortality benefit, irrespective of frailty status.

Conclusions:

• Frail ICU patients exhibit similar infection rates but a higher propensity for MDR infections compared to non-frail patients.
• Empirical broad-spectrum antibiotic therapy should be guided by microbiological risk factors, not solely by host characteristics like frailty.