Re: Predictors of In-Hospital Mortality in Elderly Patients With Bacteraemia Admitted to an Internal Medicine Ward
| Autor: | Joana Decq-Mota, Jandira Lima, José Diniz Vieira, José Manuel Nascimento Costa, Branca Pereira, Marta Rebelo |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
health care facilities manpower and services Urology MEDLINE bloodstream infection Hospital mortality elderly Internal medicine Bloodstream infection Medicine bacteremia Intensive care medicine Original Research hospital mortality lcsh:R5-920 In hospital mortality business.industry Idoso social sciences General Medicine bacterial infections and mycoses medicine.disease humanities Medicine public health Bacteremia Emergency medicine Bacteriemia Mortalidade lcsh:Medicine (General) business |
| Zdroj: | International Archives of Medicine International Archives of Medicine, Vol 4, Iss 1, p 33 (2011) |
| ISSN: | 1527-3792 0022-5347 |
| DOI: | 10.1016/j.juro.2012.02.2524 |
| Popis: | Background Infectious diseases are a common cause of increased morbidity and mortality in elderly patients. Bacteraemia in the elderly is a difficult diagnosis and a therapeutic challenge due to age-related vicissitudes and to their comorbidities. The main purpose of the study was to assess independent risk factors for in-hospital mortality among the elderly with bacteraemia admitted to an Internal Medicine Ward. Methods Overall, a cohort of 135 patients, 65 years of age and older, with bacteraemia were retrospectively studied. Data related to demographic information, comorbidities, clinical parameters on admission, source and type of infection, microorganism isolated in the blood culture, laboratory data and empirical antibiotic treatment was recorded from each patient. Multivariate logistic regression was performed to identify independent predictors of all-cause in-hospital mortality. Results Of these 135 patients, 45.9% were women. The most common infections in this group of patients were urinary tract infections (46.7%). The main microorganisms isolated in the blood cultures were Escherichia coli (14.9%), Methicillin-resistant Staphylococcus aureus (MRSA) (12.0%), non-MRSA (11.4%), Klebsiella pneumoniae (9.1%) and Enterococcus faecalis (8.0%). The in-hospital mortality was 22.2%. Independent prognostic factors associated with in-hospital mortality were age ≥ 85 years, chronic renal disease, bacteraemia of unknown focus and cognitive impairment at admission (OR, 2.812 [95% CI, 1.039-7.611; p = 0.042]; OR, 6.179 [95% CI, 1.840-20.748; p = 0.003]; OR, 8.673 [95% CI, 1.557-48.311; p = 0.014] and OR, 3.621 [95% CI, 1.226-10.695; p = 0.020], respectively). By multivariate analysis appropriate antibiotic therapy was not associated with lower odds of mortality. Conclusion Bacteraemia in the elderly has a high mortality rate. There are no set of signs or clinical features that can predict bacteraemia in the elderly. However, older age (≥ 85 years), chronic renal disease, bacteraemia of unknown focus and severe cognitive impairment adversely affects the outcome of elderly patients with bacteraemia admitted to an Internal Medicine ward. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|