Clinical characteristics and outcome of elderly patients with community-onset bacteremia
Introduction
Bacteremia is a leading cause of morbidity and mortality,1 being the eleventh cause of death in the United States.2 The incidence of sepsis increases with age, most markedly in people over 85 years3 and multiple factors contribute to this phenomenon, such as comorbidities, altered immune function, institutionalization and declining performance status.4 Aging is also a predictor of mortality in patients with sepsis and bacteremia.3, 5, 6 It is expected that by 2060 the number of people aged 65 years or over will account for 29.5% of the EU-27's population (17.5% in 2011) and therefore bacteremia and sepsis may become a major public health issue.7 Despite all this facts, there is a shortage of studies on sepsis specific to older patients.8
In patients with bloodstream infections, appropriate empirical antibiotic treatment has been commonly associated with a better outcome.9 In order to choose an appropriate empirical antibiotic treatment it is fundamental to be aware of the pathogen distribution at different infection sites and of major local resistance trends.10 It is important to take into account that age may influence both of these factors.
Although several studies on bacteremia in the elderly have been recently published, most of them have compared younger with elderly patients.5, 6, 11 The present study represents the largest series focused specifically on patients over 65 years aimed to describe the age-related characteristics of community-onset bacteremia and the predictors of 30-day mortality in this population.
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Setting and data collection
The study was performed in a 700-bed university center that provides specialized and broad medical, surgical, and intensive care for an urban population of 500,000 people. Since 1991 our institution has carried out a blood culture surveillance program identifying and monitoring all patients with bacteremia. The collected data was entered in a specific database designed for this program. Patients were prospectively followed-up for 30 days after the onset by a senior infectious disease specialist
Clinical characteristics of patients ≥65 years-old with community-onset bacteremia
Out of 4598 consecutive episodes of community-onset bacteremia, 2605 (56.7%) occurred in patients aged 65 years or over. The mean (SD) age of the study group was 78.06 (7.71) years (range, 65–106 years) and 1378 (52.9%) were male. According to age, 921 (35.4%) episodes were observed in age-group I (65–74 years), 1109 (42.6%) in group II (75–84 years) and 575 (22.1%) in group III (≥85 years). The main characteristics of patients are presented in Table 1. The proportion of males decreased with
Discussion
It is expected that in the near future the population aged 65 year or over will be on the increase. To our knowledge, this study is the largest one focusing on patients over 65 years with community-onset bacteremia, describing its characteristics, outcome and factors associated with mortality.
Consistent with previous reports, the prevalence of some comorbidities change with age, increasing some, such as neurologic impairment and cardiovascular disease, and decreasing others like diabetes,
Transparency declarations
None to declare.
Acknowledgments
This work was presented as a poster at the XVIII SEIMC (sociedad española de enfermedades infecciosas y microbiología clínica) congress (Abstract 443) (2014).
This study was supported in part by the “Fundación Máximo Soriano Jiménez” (Barcelona, Spain).
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2022, Journal of the American Medical Directors AssociationCitation Excerpt :Although early studies have reported that the treatment has no effect,6,36 recent investigations enrolling a large cohort have consistently demonstrated that it significantly reduces fatality.4–8 In line with the results of other studies dealing with the older patients with bacteremia,9,10 the prognostic effect of prompt AAT administration was evidenced herein. Superior to these previously established reports,9,10 our study also revealed that delayed AAT had both impacts on the older patients with and without initial sepsis presentations and the clinical application of the Sepsis-3 criteria in the older individuals was first reported.
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2019, American Journal of MedicineCitation Excerpt :Bacteremia is defined by the presence of a microorganism in blood culture. It accounts for 7% of infections occurring in individuals who are older4 and results in death rates of 11%-30% after 1 week5–11 and up to 45% after 1 month.12 Long-term outcomes associated with bacteremia in patients who are older, such as functional or cognitive decline, the rate of institutionalization, and quality of life, remain poorly documented.5
- d
C.H. and C.F. contributed equally to this work.