Short‐Term Mortality in Relation to Age and Comorbidity in Older Adults with Community‐Acquired Bacteremia: A Population‐Based Cohort Study

Abstract

Older age and greater comorbidity predicted mortality, and increasing age-related comorbidity did not explain the effect of age.

Bloodstream infections in older patients

“…Excluding one study, conducted in intensive care unit (ICU) patients, in all other studies urinary tract infection (UTI) is the most common source of infection, reported in 21-59% of patients. UTI was more common in older patients: both in patients 65 y and older versus younger patients 20,33,34 and in patients 80 y and older vs. patients aged 60-80. 11,35 In nursing home residents with an indwelling catheter, risk of UTI with each day that the catheter remains in place have been reported 3-7%.…”

“…11,14,35 S. aureus BSIs may be less common in the group of oldest old (>D80y). 14,19,20,33 Klebsiella spp.are the cause of BSI is elderly in approximately 3% (35) to 10%, 29 Pseudomonas aeruginosa causes between 1-9% of BSIs, with the lower rate reported in community acquired cases 33 and higher rates in nosocomial cases. 3,13 Acinetobacter baumanii in elderly is reported in few studies with rates of 1-2% 3,13,28 and up to 4% in patients 75years and older in ICU setting.…”

“…43 E. coli is the most common pathogen in community acquired BSIs in elderly 44 and causes~40% of these infections. 14,20,33 In a large series from Finland, it was the most common pathogen in men aged 65 y and older with BSI acquired in both community and nosocomial setting. 9 In nosocomial BSIs, E. coli represents 10-20% of BSIs, 3,13 while Staphylococcus aureus and Staphylococci coagulase negative assume prominence.…”

“…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.…”

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].…”