Community‐Acquired Bacteremia in the Elderly: A Prospective Study of 121 Cases

Abstract

Community-acquired bacteremia in the elderly has a high mortality rate. Early recognition and prompt, appropriate treatment are critical in reducing the mortality.

Predictors of outcome in geriatric patients with urinary tract infections

“…The elderly have an altered immune response and may fail to demonstrate traditional clinical indicators of infection (9 -12). The diagnosis of bacteremic UTI is often delayed in geriatric patients, resulting in reported mortality rates of 10% to 40% (11,(13)(14)(15). Despite risk for significant morbidity, the characteristics and outcome of elderly patients presenting to the ED with UTI have not been previously described in the literature.…”

Bloodstream infections in older patients

“…14 S. pneumonia, 22 and Enterobacteriaceaeresistantto3rdgenerationcephalosporins 14 werealso associatedwithincreasedmortality.E.coliwasdemonstratedto beprotectiveinonestudy. 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.…”

“…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. 22 …”

Association between the number of blood cultures and appropriateness of care for suspected bacteremic urinary tract infection in the elderly

“…Previous studies have investigated bacteremia in older patients, and UTI was found to be the source of bacteremia in 24-56% of the patients [2,19]. In patients with community-acquired bacteremia, 30-40% of the patients had UTI [20][21][22]. In older adults with bacteremic UTI, 80.1-83.3% of the infections were community-acquired [5,23].…”