Atypical Presentation of Bacteremia in Older Patients Is a Risk Factor for Death

Hyernard, Caroline; Breining, Alice; Duc, Sophie; Kobeh, D.; Dubos, Maria; Prével, Renaud; Cazanave, Charles; Lambert, M E; Bonnet, Fabrice; Mercié, P.; Contis, A.; Duffau, P.; Camou, Fabrice; Guerville, Florent; Rainfray, Muriel; Roubaud-Baudron, C.

doi:10.1016/j.amjmed.2019.04.049

Cited by 27 publications

(18 citation statements)

References 39 publications

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“…Conversely, initial diagnosis of UTI was associated with decreased mortality. This may be explained by the fact that atypical presentation of sepsis is associated with worse outcome in older patients [ 9 ], rather than the delay in antibiotic introduction.…”

Section: Discussionmentioning

confidence: 99%

“…In our series, the presence of UTI symptoms did not impact 90-day mortality. The current literature is inconsistent on this point [ 2 , 9 , 36 ]. Conversely, the absence of fever, reported in 40% of bacteremic patients [ 2 , 9 ], was associated with worse prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, the literature reports a greater frequency of atypical semiology of infectious diseases in older patients, and particularly atypical UTI [ 5 , 6 ]. The diagnosis of sepsis and its origin are, therefore, more difficult to determine [ 2 , 7 , 8 , 9 , 10 ]. Recently, these atypical presentations have been associated with an increased mortality in bloodstream infections [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…The diagnosis of sepsis and its origin are, therefore, more difficult to determine [ 2 , 7 , 8 , 9 , 10 ]. Recently, these atypical presentations have been associated with an increased mortality in bloodstream infections [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Atypical Presentation of Bacteremic Urinary Tract Infection in Older Patients: Frequency and Prognostic Impact

et al. 2021

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In older patients, urinary tract infection (UTI) often has an atypical clinical presentation, making its diagnosis difficult. We aimed to describe the clinical presentation in older inpatients with UTI-related bacteremia and to determine the prognostic impact of atypical presentation. This cohort study included all consecutive patients older than 75 years hospitalized in a university hospital in 2019 with a UTI-related gram-negative bacillus (GNB) bacteremia, defined by blood and urine cultures positive for the same GNB, and followed up for 90 days. Patients with typical symptoms of UTI were compared to patients with atypical forms. Among 3865 inpatients over 75 with GNB-positive urine culture over the inclusion period, 105 patients (2.7%) with bacteremic UTI were included (mean age 85.3 ± 5.9, 61.9% female). Among them, UTI symptoms were reported in only 38 patients (36.2%) and 44 patients (41.9%) had no fever on initial management. Initial diagnosis of UTI was made in only 58% of patient. Mortality at 90 days was 23.6%. After adjustment for confounders, hyperthermia (HR = 0.37; IC95 (0.14–0.97)) and early UTI diagnosis (HR = 0.35; IC95 (0.13–0.94)) were associated with lower mortality, while UTI symptoms were not associated with prognosis. In conclusion, only one third of older patients with UTI developing bacteremia had UTI symptoms. However, early UTI diagnosis was associated with better survival.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Atypical Presentation of Bacteremic Urinary Tract Infection in Older Patients: Frequency and Prognostic Impact

et al. 2021

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“…In this study www.nature.com/scientificreports www.nature.com/scientificreports/ we demonstrated that body temperature is not a reliable marker for clinicians to differentiate infectious events in patients with cirrhosis, and could overlook the disease severity of the afebrile patients, thus delaying initiation of sepsis bundle, including antibiotics treatment, resulting in higher mortality risk. Another explanation for grave prognosis in the afebrile group is the consequence of their highly impaired systemic immune response to infection, predisposing serious complications and mortality, although this had not been validated by immunological assays 35 .…”

Section: Discussionmentioning

confidence: 99%

Afebrile Bacteremia in Adult Emergency Department Patients with Liver Cirrhosis: Clinical Characteristics and Outcomes

Chen

Hsu

2020

Sci Rep

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Hung-Yu chen & Yin-chou Hsu ✉ cirrhotic patients with bacteremia are at an increased risk of organ failure and mortality. in addition, they can develop serious infection without fever because of their impaired immune response. our study aimed to investigate the clinical characteristics and outcomes in afebrile bacteremic patients with liver cirrhosis. A single-center, retrospective cohort study was performed on adult patients who visited the emergency department from January 2015 to December 2018. All patients with bacteremia and diagnosis of liver cirrhosis were enrolled and classified as either afebrile or febrile. In total, 104 bacteremic patients with liver cirrhosis (afebrile: 55 patients and, febrile: 49) were included in the study. Compared with the febrile group, patients in the afebrile group showed a significantly higher rate of inappropriate antibiotics administration (43.6% vs. 20.4%, p = 0.01). They were also at an increased risk of 30-day mortality (40% vs. 18.4%, p = 0.02), intensive care unit transfer (38.2% vs. 18.4%, p = 0.03) and endotracheal intubation (27.3% vs. 10.2%, p = 0.03). The afebrile state was also an independent risk factor associated with 30-day mortality in cirrhotic patients with bacteremia. Clinicians should perform a prudent evaluation in cirrhotic patients and carefully monitor for possible signs of serious infection even in the absence of fever. Patients with liver cirrhosis are prone to develop infection because of their cirrhosis-associated immune dysfunction, increased intestinal mucosa permeability and decreased hepatic bacteria filtration 1. Among these, bacteremia is a serious and systemic infectious disease requiring aggressive treatment and investigation 2. Compared to non-cirrhotic patients, bacteremia in cirrhotic patients shows significantly higher mortality and morbidity risk and prolonged hospitalization 3-5. Patients with fever accompanied by altered mental status and hypotension, may help clinicians to diagnose bacteremia 6. Clinicians frequently rely on the presence of fever to initiate infection workup 7 ; however, fever is a complex and non-specific host defense response against infection, and might be absent in bacteremic syndrome 8. Afebrile bacteremic patients often have atypical clinical manifestations, such as lethargy or confusion 9 , leading to decreased survival and poorer prognosis 10. It is well known that patients with cirrhosis and bacterial infection frequently present with atypical manifestation, such as normothermia 11,12 ; which makes the traditional Systemic Inflammatory Response Syndrome (SIRS) criteria inaccurate in the identification of patients with infection 11,13. It has been proposed that scoring systems focused on organ dysfunction, such as quick Sequential Organ Failure Assessment (qSOFA) score or Chronic Liver Failure Sequential Organ Failure Assessment (CLIF-SOFA) score have better prediction ability in sepsis and prognosis stratification in patients with cirrhosis 13. Despite this, previous studies regarding bacteremia in cirrhot...

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Infectious diseases and cognition: do we have to worry?

et al. 2022

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Objectives Age-related physiological changes, particularly immune system decline, may contribute to greater vulnerability to infectious diseases in older individuals. A growing body of evidence shows that both, acute, and chronic infections may be accompanied by cognitive disturbances as part of their manifestations. Given the importance of cognition in aging trajectories, the objective of this article was to review current knowledge on cognitive outcomes of infectious diseases in older adults, and to emphasize the importance of considering cognition as a domain of interest in its own rights in these diseases. Methods A MEDLINE/PubMed database search was conducted to identify articles reporting cognitive impairment associated with various severe acute infections and specific chronic infectious conditions such as human immune deficiency virus, the herpes virus family, hepatitis C virus, Lyme borreliosis, Helicobacter pylori, periodontitis, and emerging pathogens like SARS-CoV-2, as well as potentially preventive strategies like vaccination. Results/ Conclusions Taken together, the studies examined in the present review emphasize that numerous acute and chronic infectious diseases share mechanisms that, when added to specific risk factors frequently found in older persons, contribute to considerably increase the risk of cognitive outcomes such as cognitive decline and dementia. This review may help to appreciate the role that infectious diseases play in cognitive trajectories and thus promote further investigation on the topic.

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Atypical Presentation of Bacteremia in Older Patients Is a Risk Factor for Death

Cited by 27 publications

References 39 publications

Atypical Presentation of Bacteremic Urinary Tract Infection in Older Patients: Frequency and Prognostic Impact

Atypical Presentation of Bacteremic Urinary Tract Infection in Older Patients: Frequency and Prognostic Impact

Afebrile Bacteremia in Adult Emergency Department Patients with Liver Cirrhosis: Clinical Characteristics and Outcomes

Infectious diseases and cognition: do we have to worry?

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