Bacteriemia en pacientes muy ancianos: factores de riesgo, características clínicas y mortalidad

Payeras, Antoni; García-Gasalla, Mercedes; Garau, Margarita; Roca, M; Pareja, Antonio; Cifuentes, Carmen; Homar, Francesc; Gallegos, Carmen; Bassa, Antoni

doi:10.1157/13112936

Cited by 17 publications

(7 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The most frequent source of bacteremia (44.3%) was, predictably, the urinary tract, as in previous studies 4,27,30 . The source of bacteremia was similar in both age groups, but the origin was more frequently in the lower respiratory tract in the 90+ age group.…”

Section: Discussionsupporting

confidence: 81%

See 1 more Smart Citation

The quick Sepsis-related Organ Failure Assessment (qSOFA) is a good predictor of in-hospital mortality in very elderly patients with bloodstream infections: A retrospective observational study

Ramos‐Rincón

Fernández-Gil

Merino

et al. 2019

Sci Rep

View full text Add to dashboard Cite

People over 80 years old are now the fastest-growing age group. Bloodstream infections (BSI) in these patients may present with specific characteristics. The objective of this study was to analyze independent factors affecting in-hospital mortality (IHM) due to BSI in very elderly patients (≥80 years of age) and to compare the clinical presentation of BSI in patients aged 80–89 years versus those aged 90 or more. Retrospective, cross-sectional and observational study of BSI in patients aged 80 years or older. The study used IHM as the primary outcome. Stepwise multiple logistic regression models were used to identify associations between potential predictors and IHM. Of the 336 included patients, 76.8% (n = 258) were in the 80–89-year age group and 23.2% (n = 78) in the 90+ age group; 17.3% (n = 58) of patients died during admission. This outcome was independently associated with quick Sepsis Related Organ Failure Assessment (qSOFA) of 2 or more (adjusted odds ratio [aOR] 4.7, 95% confidence interval [CI] 2.3–9.4; p < 0.001). Other predictors included an origin of BSI outside the urinary tract (aOR 5.5, 95% CI 2.4–12.6; p < 0.001), thrombocytopenia (aOR 4.9, 95% CI 1.8–13.4; p = 0.002), hospital-acquired infection (aOR 3.0, 95% CI 1.2–7.5; p = 0.015), and inappropriate empiric antibiotics (aOR 2.0, 95% CI 1.1–3.9; p = 0.04). IHM was 23.1% in the 90+ age group and 15.5% in patients aged 80 to 89 (p = 0.012). However, the 90+ age group was more likely to have a score of at least 2 on the qSOFA (29.9% vs. 19.1%, p = 0.043) and Pitt bacteremia scales (44.9% vs. 30.2%; p = 0.02), as well as chronic kidney disease (56.4% vs. 36.0%; p = 0.001) and altered mental state (40.3% vs. 25.7%; p = 0.013). In conclusion: A qSOFA score of 2 or more and a BSI originating outside the urinary tract were independent predictors of IHM. The 90+ age group was at higher risk than the 80–89-year age group of having a qSOFA score and Pitt bacteremia score of 2 or more as well as an altered mental state.

show abstract

Section: Discussionsupporting

confidence: 81%

“…The urinary tract is the main origin of bacteremia, which is concordant with the fact that E. coli , the main microorganism causing bacteremia in elderly patients 27,30,32 , was the most prevalent pathogen, followed by Enterococcus spp. and Kelbsiella spp.…”

Section: Discussionmentioning

confidence: 61%

The quick Sepsis-related Organ Failure Assessment (qSOFA) is a good predictor of in-hospital mortality in very elderly patients with bloodstream infections: A retrospective observational study

Ramos‐Rincón

Fernández-Gil

Merino

et al. 2019

Sci Rep

View full text Add to dashboard Cite

show abstract

“…60 Factors contributing to this difference include senescence of both humoral and cell-mediated immune systems; reduced physiologic reserve capacity; increased incidence of underlying illnesses; poor tolerance to invasive diagnostic and therapeutic procedures; greater risk and incidence of nosocomial infections; and higher rates of adverse reactions to drugs, including antibiotics. 4,28 Predictors of mortality in elderly in most studies include increasingage, 3,8,11,13,14,20,22,28,29,33,47,61 noncommunityacquisition, 11,14,28,61,62 poor functional status, 3,11,61,63,64 comorbidities, 14,22,29,33,47 respiratory, 13 35 Enterococcus spp. 14 S. pneumonia, 22 and Enterobacteriaceaeresistantto3rdgenerationcephalosporins 14 werealso associatedwithincreasedmortality.E.coliwasdemonstratedto beprotectiveinonestudy.…”

Section: Mortalitymentioning

confidence: 99%

“…48 InalargestudyfromFinland,thecase fatalityproportionsofGram-negativeBSIinpeople>D65ywas highercomparedtoyoungerpatientsandreached13%. 9 Another predictor of mortality is the use of inappropriate empiric antibiotic therapy 11,14,28,[46][47][48] and age is an important risk factor of carriage of multidrug resistant organisms leading possibly to higher rates of inappropriate empirical antibiotic treatment in elderly patients. 6 Clinical signs at presentation predicting mortality among the elderly include hypotension/ shock, 11,13,14,46,48,61 absence of fever, 14,22 low albumin, 11,41,61 elevated renal creatinine/ urea, 11,13,61 leukopenia, 22,61 change in mental status, 29,48 and in single studies other measures such as tachycardia or tachypnea, 61 elevated CRP 41 and early organ failure.…”

Section: Mortalitymentioning

confidence: 99%

Bloodstream infections in older patients

et al. 2016

View full text Add to dashboard Cite

“…Bacteraemia is associated with an increased length of stay, higher rates of readmission, poor clinical outcomes and mortality, and a high economic burden [ 3 , 4 ]. Elderly patients with co-morbidities, particularly malignancies, are at a higher risk of bacteraemia [ 3 , 5 ]. The incidence of bacteraemia is expected to increase, with ageing populations and increased longevity of patients with chronic conditions due to medical advancements [ 3 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Comparative epidemiology of bacteraemia in two ageing populations: Singapore and Denmark

Sim,

Li,

Aung

et al. 2024

Epidemiol. Infect.

View full text Add to dashboard Cite

Burden of bacteraemia is rising due to increased average life expectancy in developed countries. This study aimed to compare the epidemiology and outcomes of bacteraemia in two similarly ageing populations with different ethnicities in Singapore and Denmark. Historical cohorts from the second largest acute-care hospital in Singapore and in the hospitals of two Danish regions included patients aged 15 and above who were admitted from 1 January 2006 to 31 December 2016 with at least 1 day of hospital stay and a pathogenic organism identified. Among 13 144 and 39 073 bacteraemia patients from Singapore and Denmark, similar 30-day mortality rates (16.5%; 20.3%), length of hospital stay (median 14 (IQR: 9-28) days; 11 (6-21)), and admission rate to ICU (15.5%; 15.6%) were observed, respectively. Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus ranked among the top four in both countries. However, Singaporeans had a higher proportion of patients with diabetes (46.8%) and renal disease (29.5%) than the Danes (28.0% and 13.7%, respectively), whilst the Danes had a higher proportion of patients with chronic pulmonary disease (18.0%) and malignancy (35.3%) than Singaporeans (9.7% and 16.2%, respectively). Our study showed that top four causative organisms and clinical outcomes were similar between the two cohorts despite pre-existing comorbidities differed.

show abstract

Bacteriemia en pacientes muy ancianos: factores de riesgo, características clínicas y mortalidad

Cited by 17 publications

References 14 publications

The quick Sepsis-related Organ Failure Assessment (qSOFA) is a good predictor of in-hospital mortality in very elderly patients with bloodstream infections: A retrospective observational study

The quick Sepsis-related Organ Failure Assessment (qSOFA) is a good predictor of in-hospital mortality in very elderly patients with bloodstream infections: A retrospective observational study

Bloodstream infections in older patients

Comparative epidemiology of bacteraemia in two ageing populations: Singapore and Denmark

Contact Info

Product

Resources

About