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Published in: BMC Geriatrics 1/2023

Open Access 01-12-2023 | Eosinopenia | Research

Association between low eosinophil count and acute bacterial infection, a prospective study in hospitalized older adults

Authors: Léa Mésinèle, Tom Pujol, Nicoletta Brunetti, Marie Neiss, Christophe Trivalle, Cecile Souques, Nadège Houenou-Quenum, Sébastien Verdier, Pauline Simon, Anne-Laure Vetillard, Julie Houdre, Rocco Collarino, Morgane Mary, Jean-Sébastien Vidal, Jean-Emmanuel Kahn, Magali Guichardon, Emmanuelle Duron, Edouard Baudouin

Published in: BMC Geriatrics | Issue 1/2023

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Abstract

Background

The incidence of sepsis increases significantly with age, including a high incidence of bacterial infection in the old adults. Eosinopenia and the CIBLE score have been proposed in critically ill adults and in internal medicine wards. This study aimed to assess whether a low eosinophil count was associated with acute bacterial infection among hospitalized older adults, and to find the most efficient eosinophil count cut-off to differentiate acute bacterial infection from other inflammatory states.

Methods

This was a prospective study from July 2020 to July 2022 in geriatric wards of the University Paul Brousse Hospital (Villejuif, France) including patients aged of 75 y/o or over suffering from fever or biological inflammation. Acute bacterial infection was assessed using biological identification and/or clinical and radiological data.

Results

A total of 156 patients were included. Eighty-two (53%) patients suffered from acute bacterial infection (mean age (SD) 88.7 (5.9)). Low eosinophil count was independently associated with acute bacterial infection: OR [CI95%] 3.03 [1.04–9.37] and 6.08 [2.42–16.5] for eosinophil count 0–0.07 G/L and 0.07–0.172 G/L respectively (vs. eosinophil count > 0.172 G/L). Specificity and sensitivity for eosinophil count < 0.01 G/L and CIBLE score were 84%-49% and 72%-62%, respectively with equivalent AUCs (0.66 and 0.67).

Conclusion

Eosinophil count < 0.01 G/L is a simple, routinely used and inexpensive tool which can easily participate in antibiotic decisions for older adults. Further studies are needed to assess clinical benefits.

Trial registration

The study was registered at Clinical trial.gov (NCT04363138–23/04/2020).
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Literature
1.
go back to reference Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med Juill. 2001;29(7):1303.CrossRef Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med Juill. 2001;29(7):1303.CrossRef
2.
go back to reference Du WY, Yin CN, Wang HT, Li ZW, Wang WJ, Xue FZ et al. Infectious Diseases among elderly persons: results from a population-based observational study in Shandong province, China, 2013–2017. J Glob Health. 11:08010. Du WY, Yin CN, Wang HT, Li ZW, Wang WJ, Xue FZ et al. Infectious Diseases among elderly persons: results from a population-based observational study in Shandong province, China, 2013–2017. J Glob Health. 11:08010.
3.
go back to reference Norman DC, Yoshikawa TT. Fever in the elderly. Infect Dis Clin North Am mars. 1996;10(1):93–9.CrossRef Norman DC, Yoshikawa TT. Fever in the elderly. Infect Dis Clin North Am mars. 1996;10(1):93–9.CrossRef
4.
go back to reference Ravin KA, Loy M. The Eosinophil in Infection. Clin Rev Allergy Immunol avr. 2016;50(2):214–27.CrossRef Ravin KA, Loy M. The Eosinophil in Infection. Clin Rev Allergy Immunol avr. 2016;50(2):214–27.CrossRef
5.
go back to reference Yoshikawa TT. Epidemiology and unique aspects of aging and infectious Diseases. Clin Infect Dis off Publ Infect Dis Soc Am juin. 2000;30(6):931–3.CrossRef Yoshikawa TT. Epidemiology and unique aspects of aging and infectious Diseases. Clin Infect Dis off Publ Infect Dis Soc Am juin. 2000;30(6):931–3.CrossRef
6.
go back to reference Choi C. Bacterial Meningitis in aging adults. Clin Infect Dis off Publ Infect Dis Soc Am 15 oct. 2001;33(8):1380–5.CrossRef Choi C. Bacterial Meningitis in aging adults. Clin Infect Dis off Publ Infect Dis Soc Am 15 oct. 2001;33(8):1380–5.CrossRef
7.
go back to reference Stocks G, Janssen HF. Infection in patients after implantation of an orthopedic device. ASAIO J Am Soc Artif Intern Organs 1992. 2000;46(6):41–6.CrossRef Stocks G, Janssen HF. Infection in patients after implantation of an orthopedic device. ASAIO J Am Soc Artif Intern Organs 1992. 2000;46(6):41–6.CrossRef
8.
go back to reference Marrie TJ. Community-acquired Pneumonia in the elderly. Clin Infect Dis off Publ Infect Dis Soc Am oct. 2000;31(4):1066–78.CrossRef Marrie TJ. Community-acquired Pneumonia in the elderly. Clin Infect Dis off Publ Infect Dis Soc Am oct. 2000;31(4):1066–78.CrossRef
9.
go back to reference Chassagne P, Perol MB, Doucet J, Trivalle C, Ménard JF, Manchon ND. Is presentation of bacteremia in the elderly the same as in younger patients? Am J Med. Jan; 1996;100(1):65–70.CrossRefPubMed Chassagne P, Perol MB, Doucet J, Trivalle C, Ménard JF, Manchon ND. Is presentation of bacteremia in the elderly the same as in younger patients? Am J Med. Jan; 1996;100(1):65–70.CrossRefPubMed
10.
go back to reference Norman DC, Toledo SD. Infections in elderly persons. An altered clinical presentation. Clin Geriatr Med. (v; 1992;8(4):713–9.CrossRefPubMed Norman DC, Toledo SD. Infections in elderly persons. An altered clinical presentation. Clin Geriatr Med. (v; 1992;8(4):713–9.CrossRefPubMed
11.
go back to reference Yan L, Liao P, Xu LL, Zhao Y. Usefulness of procalcitonin in elderly patients with bacterial Infection. Clin Lab. 2014;60(1):139–42.PubMed Yan L, Liao P, Xu LL, Zhao Y. Usefulness of procalcitonin in elderly patients with bacterial Infection. Clin Lab. 2014;60(1):139–42.PubMed
12.
go back to reference Ticinesi A, Lauretani F, Nouvenne A, Porro E, Fanelli G, Maggio M, et al. C-reactive protein (CRP) measurement in geriatric patients hospitalized for acute Infection. Eur J Intern Med janv. 2017;37:7–12.CrossRef Ticinesi A, Lauretani F, Nouvenne A, Porro E, Fanelli G, Maggio M, et al. C-reactive protein (CRP) measurement in geriatric patients hospitalized for acute Infection. Eur J Intern Med janv. 2017;37:7–12.CrossRef
13.
go back to reference Nakayama T, Sonoda S, Urano T, Yamada T, Okada M. Monitoring both serum amyloid protein A and C-reactive protein as inflammatory markers in infectious Diseases. Clin Chem. Feb; 1993;39(2):293–7.CrossRefPubMed Nakayama T, Sonoda S, Urano T, Yamada T, Okada M. Monitoring both serum amyloid protein A and C-reactive protein as inflammatory markers in infectious Diseases. Clin Chem. Feb; 1993;39(2):293–7.CrossRefPubMed
14.
go back to reference Delèvaux I, André M, Colombier M, Albuisson E, Meylheuc F, Bègue RJ, et al. Can procalcitonin measurement help in differentiating between bacterial Infection and other kinds of inflammatory processes? Ann Rheum Dis avr. 2003;62(4):337–40.CrossRef Delèvaux I, André M, Colombier M, Albuisson E, Meylheuc F, Bègue RJ, et al. Can procalcitonin measurement help in differentiating between bacterial Infection and other kinds of inflammatory processes? Ann Rheum Dis avr. 2003;62(4):337–40.CrossRef
15.
go back to reference Gurwitz JH, Field TS, Avorn J, McCormick D, Jain S, Eckler M. Incidence and preventability of adverse drug events in nursing homes. Am J Med août. 2000;1(2):87–94.CrossRef Gurwitz JH, Field TS, Avorn J, McCormick D, Jain S, Eckler M. Incidence and preventability of adverse drug events in nursing homes. Am J Med août. 2000;1(2):87–94.CrossRef
16.
go back to reference Bass DA, Gonwa TA, Szejda P, Cousart MS, DeChatelet LR, McCall CE. Eosinopenia of Acute Infection. J Clin Invest juin. 1980;65(6):1265–71.CrossRef Bass DA, Gonwa TA, Szejda P, Cousart MS, DeChatelet LR, McCall CE. Eosinopenia of Acute Infection. J Clin Invest juin. 1980;65(6):1265–71.CrossRef
17.
go back to reference Gil H, Magy N, Mauny F, Dupond JL. Valeur De l’éosinopénie dans le diagnostic des syndromes inflammatoires: un « vieux » marqueur revisité. Rev Médecine Interne Juill. 2003;24(7):431–5.CrossRef Gil H, Magy N, Mauny F, Dupond JL. Valeur De l’éosinopénie dans le diagnostic des syndromes inflammatoires: un « vieux » marqueur revisité. Rev Médecine Interne Juill. 2003;24(7):431–5.CrossRef
18.
go back to reference Bouldoires B, Gil H, Soumagne T, Humbert S, Meaux Ruault N, Magy Bertrand N. Proposition d’un score prédictif d’infection bactérienne selon le taux d’éosinophiles: étude observationnelle. Rev Médecine Interne. Jan; 2018;39(1):10–6.CrossRef Bouldoires B, Gil H, Soumagne T, Humbert S, Meaux Ruault N, Magy Bertrand N. Proposition d’un score prédictif d’infection bactérienne selon le taux d’éosinophiles: étude observationnelle. Rev Médecine Interne. Jan; 2018;39(1):10–6.CrossRef
19.
go back to reference Davido B, Makhloufi S, Matt M, Calin R, Senard O, Perronne C. Changes in eosinophil count during bacterial Infection: revisiting an old marker to assess the efficacy of antimicrobial therapy. Int J Infect Dis. 2017;61:62–6.CrossRefPubMed Davido B, Makhloufi S, Matt M, Calin R, Senard O, Perronne C. Changes in eosinophil count during bacterial Infection: revisiting an old marker to assess the efficacy of antimicrobial therapy. Int J Infect Dis. 2017;61:62–6.CrossRefPubMed
20.
21.
go back to reference Outh R, Boutin C, Gueudet P, Suzuki M, Saada M, Aumaître H. Eosinopenia < 100/µL as a marker of active COVID-19: an observational prospective study. J Microbiol Immunol Infect Wei Mian Yu Gan Ran Za Zhi févr. 2021;54(1):61–8.CrossRef Outh R, Boutin C, Gueudet P, Suzuki M, Saada M, Aumaître H. Eosinopenia < 100/µL as a marker of active COVID-19: an observational prospective study. J Microbiol Immunol Infect Wei Mian Yu Gan Ran Za Zhi févr. 2021;54(1):61–8.CrossRef
22.
go back to reference Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRefPubMed Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRefPubMed
23.
go back to reference Michels WM, Grootendorst DC, Verduijn M, Elliott EG, Dekker FW, Krediet RT. Performance of the Cockcroft-Gault, MDRD, and new CKD-EPI formulas in relation to GFR, age, and body size. Clin J Am Soc Nephrol CJASN juin. 2010;5(6):1003–9.CrossRef Michels WM, Grootendorst DC, Verduijn M, Elliott EG, Dekker FW, Krediet RT. Performance of the Cockcroft-Gault, MDRD, and new CKD-EPI formulas in relation to GFR, age, and body size. Clin J Am Soc Nephrol CJASN juin. 2010;5(6):1003–9.CrossRef
25.
go back to reference Katz S, Akpom CA. A measure of primary sociobiological functions. Int J Health Serv Plan Adm Eval. 1976;6(3):493–508.CrossRef Katz S, Akpom CA. A measure of primary sociobiological functions. Int J Health Serv Plan Adm Eval. 1976;6(3):493–508.CrossRef
26.
go back to reference Folstein M, Anthony JC, Parhad I, Duffy B, Gruenberg EM. The meaning of cognitive impairment in the elderly. J Am Geriatr Soc avr. 1985;33(4):228–35.CrossRef Folstein M, Anthony JC, Parhad I, Duffy B, Gruenberg EM. The meaning of cognitive impairment in the elderly. J Am Geriatr Soc avr. 1985;33(4):228–35.CrossRef
27.
go back to reference Cunha BA. nov. Pneumonia in the elderly. Clin Microbiol infect off publ eur soc clin Microbiol Infect Dis. 2001;7(11):581–8. Cunha BA. nov. Pneumonia in the elderly. Clin Microbiol infect off publ eur soc clin Microbiol Infect Dis. 2001;7(11):581–8.
28.
go back to reference Lin Y, Rong J, Zhang Z. Silent existence of eosinopenia in sepsis: a systematic review and meta-analysis. BMC Infect Dis mai. 2021;24(1):471.CrossRef Lin Y, Rong J, Zhang Z. Silent existence of eosinopenia in sepsis: a systematic review and meta-analysis. BMC Infect Dis mai. 2021;24(1):471.CrossRef
29.
go back to reference Kaminsky P, Deibener J, Lesesve JF, Humbert JC. [Changes in hemogram parameters in Infections]. Rev Med Interne févr. 2002;23(2):132–6.CrossRef Kaminsky P, Deibener J, Lesesve JF, Humbert JC. [Changes in hemogram parameters in Infections]. Rev Med Interne févr. 2002;23(2):132–6.CrossRef
30.
go back to reference Partouche B, Pepin M, de Farcy PM, Kahn JE, Sawczynski B, Lechowski L, et al. Persistent eosinopenia is associated with in-hospital mortality among older patients: unexpected prognostic value of a revisited biomarker. BMC Geriatr. oct 2021;14(1):557. Partouche B, Pepin M, de Farcy PM, Kahn JE, Sawczynski B, Lechowski L, et al. Persistent eosinopenia is associated with in-hospital mortality among older patients: unexpected prognostic value of a revisited biomarker. BMC Geriatr. oct 2021;14(1):557.
32.
go back to reference Ramirez GA, Yacoub MR, Ripa M, Mannina D, Cariddi A, Saporiti N, et al. Eosinophils from physiology to Disease: a Comprehensive Review. BioMed Res Int. 2018;2018:1–28.CrossRef Ramirez GA, Yacoub MR, Ripa M, Mannina D, Cariddi A, Saporiti N, et al. Eosinophils from physiology to Disease: a Comprehensive Review. BioMed Res Int. 2018;2018:1–28.CrossRef
33.
go back to reference Baumann A, Gönnenwein S, Bischoff SC, Sherman H, Chapnik N, Froy O, et al. The circadian clock is functional in eosinophils and mast cells. Immunol déc. 2013;140(4):465–74.CrossRef Baumann A, Gönnenwein S, Bischoff SC, Sherman H, Chapnik N, Froy O, et al. The circadian clock is functional in eosinophils and mast cells. Immunol déc. 2013;140(4):465–74.CrossRef
34.
go back to reference Jarad N. Chronic Obstructive Pulmonary Disease (COPD) and old age? Chron Respir Dis. 2011;8(2):143–51.CrossRefPubMed Jarad N. Chronic Obstructive Pulmonary Disease (COPD) and old age? Chron Respir Dis. 2011;8(2):143–51.CrossRefPubMed
35.
go back to reference Yang M, Liu X, Hu Q, Li J, Fu S, Chen D, et al. Eosinopenia as a biomarker for antibiotic use in COPD exacerbations: protocol for a retrospective hospital-based cohort study. BMJ Open 20 janv. 2022;12(1):e051939.CrossRef Yang M, Liu X, Hu Q, Li J, Fu S, Chen D, et al. Eosinopenia as a biomarker for antibiotic use in COPD exacerbations: protocol for a retrospective hospital-based cohort study. BMJ Open 20 janv. 2022;12(1):e051939.CrossRef
36.
go back to reference Karakonstantis S, Kalemaki D, Tzagkarakis E, Lydakis C. Pitfalls in studies of eosinopenia and neutrophil-to-lymphocyte count ratio. Infect Dis 4 mars. 2018;50(3):163–74.CrossRef Karakonstantis S, Kalemaki D, Tzagkarakis E, Lydakis C. Pitfalls in studies of eosinopenia and neutrophil-to-lymphocyte count ratio. Infect Dis 4 mars. 2018;50(3):163–74.CrossRef
37.
go back to reference Jump RLP, Crnich CJ, Mody L, Bradley SF, Nicolle LE, Yoshikawa TT. Infectious Diseases in older adults of Long-Term Care facilities: Update on Approach to diagnosis and management. J Am Geriatr Soc. 2018;66(4):789–803.CrossRefPubMedPubMedCentral Jump RLP, Crnich CJ, Mody L, Bradley SF, Nicolle LE, Yoshikawa TT. Infectious Diseases in older adults of Long-Term Care facilities: Update on Approach to diagnosis and management. J Am Geriatr Soc. 2018;66(4):789–803.CrossRefPubMedPubMedCentral
38.
go back to reference Baclet N, Ficheur G, Alfandari S, Ferret L, Senneville E, Chazard E, et al. Explicit definitions of potentially inappropriate prescriptions of antibiotics in older patients: a compilation derived from a systematic review. Int J Antimicrob Agents Nov. 2017;50(5):640–8.CrossRef Baclet N, Ficheur G, Alfandari S, Ferret L, Senneville E, Chazard E, et al. Explicit definitions of potentially inappropriate prescriptions of antibiotics in older patients: a compilation derived from a systematic review. Int J Antimicrob Agents Nov. 2017;50(5):640–8.CrossRef
Metadata
Title
Association between low eosinophil count and acute bacterial infection, a prospective study in hospitalized older adults
Authors
Léa Mésinèle
Tom Pujol
Nicoletta Brunetti
Marie Neiss
Christophe Trivalle
Cecile Souques
Nadège Houenou-Quenum
Sébastien Verdier
Pauline Simon
Anne-Laure Vetillard
Julie Houdre
Rocco Collarino
Morgane Mary
Jean-Sébastien Vidal
Jean-Emmanuel Kahn
Magali Guichardon
Emmanuelle Duron
Edouard Baudouin
Publication date
01-12-2023
Publisher
BioMed Central
Keyword
Eosinopenia
Published in
BMC Geriatrics / Issue 1/2023
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-023-04581-y

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