Advanced Age is not a Risk Factor for Mortality in Patients with Bacteremia Caused by Extended-Spectrum β-Lactamase-Producing Organisms: a Multicenter Cohort Study

Abstract

A 5-year multicenter retrospective cohort study was conducted across six hospitals in Niigata, Japan. Patients (n = 179) with bacteremia due to ESBL-producing organisms were included in the study. The rate of appropriate carbapenem prescription was 41 (61%) in patients aged 65-84 years and 31 (89%) in those aged ≥85 years; patients aged ≥85 years were significantly more like to receive a carbapenem than their younger counterparts. After propensity score matching, 65 patients were assigned to two groups based on age (65-84 years or ≥85 years). Multivariate regression analysis showed that other sites of infection had a positive association with 30-day mortality (odds ratio [OR] 27.50, 95% confidence interval [CI] 2.90-260.00) and biliary tract infection tended to have a positive association with 30-day mortality (OR 8.90, 95% CI 0.88-89.90) compared with urinary tract infection. However, age ≥85 years was not associated with 30-day mortality. Elderly patients aged ≥85 years were more likely to be treated with carbapenem; however, being elderly was not associated with 30-day mortality when bacteremia was caused by ESBL-producing organisms. These results may help clinicians justify withholding carbapenem in patients over 85 years of age.

The Effect of Antibiotic Resistance and Inappropriate Empirical Antibiotic Therapy on 3-Day and 28-Day Mortality in Bacteremic Patients in the Intensive Care Unit: 5-Year Retrospective Analysis

“…It can be predicted that methods to reduce unnecessary antibiotic use, such as the implementation of rational antibiotic management programs and national planning to restrict antibiotic use, will contribute to decreasing antibiotic resistance and the reduction of the mortality rates of BSI in the ICU in the future. The 28-day mortality rate in this study was consistent with other studies (2)(3)(4)9,16,17). No studies in the literature show the 3-day mortality rate, but Evans et al (2), and Hattori et al (3) reported 7-day mortality rates of 6.7% and 11%, respectively.…”

“…It has been stated in many publications that CCIS and APACHE II scores were useful in 28-day mortality estimations in BSI (3,8,9,12,15,16). We found that both high APACHE II scores and CCIS were risk factors for 3-day and 28-day mortality.…”