Pilar Retamar1, María Dolores López-Prieto2, Fernando Rodríguez-López3, Marina de Cueto4, María V García5, Verónica González-Galan6, Alfonso Del Arco7, María J Pérez-Santos8, Francisco Téllez-Pérez9, Berta Becerril-Carral10, Andrés Martín-Aspas11, Ascensión Arroyo12, Salvador Pérez-Cortés2, Federico Acosta13, Carmen Florez14, Laura León-Ruiz15, Leopoldo Muñoz-Medina16, Jesús Rodríguez-Baño17. 1. Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain; Red Española de Investigación en Patología Infecciosa, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: pilaretamar@hotmail.com. 2. Unidad Clínica de Microbiología y Enfermedades Infecciosas, Hospital del SAS, Jerez de la Frontera, Cádiz, Spain. 3. Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Reina Sofía, Córdoba, Spain. 4. Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain. 5. Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain. 6. Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Seville, Spain. 7. Unidades de Enfermedades Infecciosas, Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain. 8. Servicio de Microbiología, Hospital de la Serranía, Ronda, Málaga, Spain. 9. Unidad de Enfermedades Infecciosas, Hospital de La Línea, Cádiz, Spain. 10. Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Punta de Europa, Algeciras, Cádiz, Spain. 11. Servicio de Medicina Interna, Hospital Puerta del Mar, Cádiz, Spain. 12. Unidad de Enfermedades Infecciosas y Microbiología, Complejo Hospitalario de Jaén, Jaén, Spain. 13. Servicio de Microbiología, Hospital de Antequera, Málaga, Spain. 14. Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Seville, Spain. 15. Sección de Enfermedades Infecciosas, Hospital Torrecárdenas, Almería, Spain. 16. Unidad de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Granada, Spain. 17. Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain; Red Española de Investigación en Patología Infecciosa, Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, University of Seville, Spain.
Abstract
OBJECTIVES: The proportion of very elderly people in the population is increasing, and infectious diseases in this patient group may present with specific characteristics. The objective of this study was to investigate the outcome predictors of bacteremia among the very elderly. METHODS: This was a multicenter prospective cohort study of bloodstream infections (BSI) in patients ≥ 80 years old in 15 hospitals in Spain. The outcome variables were 14-day and 30-day mortality. Multivariate analysis was performed. RESULTS: One hundred and twenty episodes were included. Mortality was 22% (n = 26) on day 14 and 28% (n = 34) on day 30. In the univariate analysis, the variables associated with mortality were neutropenia, recent surgery, Pitt score ≥ 2, intensive care unit (ICU) admission, severe sepsis or shock, and abdominal, unknown, and respiratory tract sources. In the multivariate analysis, variables associated with mortality on day 14 were high-risk source (abdominal, unknown, and respiratory tract sources; odds ratio (OR) 7.9, 95% confidence interval (CI) 1.8-33.9), Pitt score ≥ 2 (OR 5.6, 95% CI 1.3-23.3), inadequate empirical treatment (OR 11.24, 95% CI 1.6-80.2), and severe sepsis or shock at presentation (OR 5.3, 95% CI 1.4-20.7); the interaction between empiric treatment and high-risk source was significant. On day 30, mortality was independently related to a high-risk source (OR 2.92, 95% CI 1.1-7.5) and presentation with severe sepsis or shock (OR 3.81, 95% CI 1.2-12.4). CONCLUSIONS: Presentation with severe sepsis or shock and a high-risk source of BSI were independent predictors of 14-day and 30-day mortality. Inadequate empirical treatment was also a predictor of early mortality in patients with a high-risk source.
OBJECTIVES: The proportion of very elderly people in the population is increasing, and infectious diseases in this patient group may present with specific characteristics. The objective of this study was to investigate the outcome predictors of bacteremia among the very elderly. METHODS: This was a multicenter prospective cohort study of bloodstream infections (BSI) in patients ≥ 80 years old in 15 hospitals in Spain. The outcome variables were 14-day and 30-day mortality. Multivariate analysis was performed. RESULTS: One hundred and twenty episodes were included. Mortality was 22% (n = 26) on day 14 and 28% (n = 34) on day 30. In the univariate analysis, the variables associated with mortality were neutropenia, recent surgery, Pitt score ≥ 2, intensive care unit (ICU) admission, severe sepsis or shock, and abdominal, unknown, and respiratory tract sources. In the multivariate analysis, variables associated with mortality on day 14 were high-risk source (abdominal, unknown, and respiratory tract sources; odds ratio (OR) 7.9, 95% confidence interval (CI) 1.8-33.9), Pitt score ≥ 2 (OR 5.6, 95% CI 1.3-23.3), inadequate empirical treatment (OR 11.24, 95% CI 1.6-80.2), and severe sepsis or shock at presentation (OR 5.3, 95% CI 1.4-20.7); the interaction between empiric treatment and high-risk source was significant. On day 30, mortality was independently related to a high-risk source (OR 2.92, 95% CI 1.1-7.5) and presentation with severe sepsis or shock (OR 3.81, 95% CI 1.2-12.4). CONCLUSIONS: Presentation with severe sepsis or shock and a high-risk source of BSI were independent predictors of 14-day and 30-day mortality. Inadequate empirical treatment was also a predictor of early mortality in patients with a high-risk source.
Authors: G Chapelet; A S Boureau; A Dylis; G Herbreteau; S Corvec; E Batard; G Berrut; L de Decker Journal: Eur J Clin Microbiol Infect Dis Date: 2017-08-12 Impact factor: 3.267
Authors: A Del Arco; J Olalla; J de la Torre; A Blázquez; N Montiel-Quezel; J L Prada; F Rivas; J García-Alegría; F Fernández-Sánchez Journal: BMC Infect Dis Date: 2017-05-22 Impact factor: 3.090