Predictors of Mortality with Staphylococcus aureus Bacteremia in Elderly Adults
Predictors of Mortality with Staphylococcus aureus Bacteremia in Elderly Adults
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DOI：
10.1111/jgs.15391
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发表时间：
2018-07-01
影响因子：
6.3
通讯作者：
Carnelutti, Alessia
中科院分区：
文献类型：
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作者：
Bassetti, Matteo;Righi, Elda;Carnelutti, Alessia
目的分析意大利75岁及以上金黄色葡萄球菌菌血症（SAB）患者早期和晚期死亡的危险因素。设计（2011年1月-2014年12月）。设置意大利的两所三级护理大学医院（乌迪内的圣玛利亚Misericordia医院，罗马的Agostino Gemelli大学综合医院）。内裤所有连续入院的SAB成人。测量临床表现，感染特征，结果本组共确诊SAB 337例，其中75岁以上患者118例（35%）。老年人的7天（20.3% vs 9.2%）和30天（35.7% vs 20.7%）死亡率显著高于年轻人。感染性休克的临床表现、经验性抗生素治疗的充分性和肝硬化被认为是老年SAB患者7天死亡率的预测因素。与30天死亡率独立相关的危险因素包括耐甲氧西林金黄色葡萄球菌（MRSA）的分离和不接受传染病consultation.ConclusionMortality是显着较高的老年人比年轻的成年人与SAB，特别是在那些呈现脓毒性休克，肝硬化，或SAB由于MRSA。死亡的其他风险因素包括不适当的经验性抗生素治疗和未接受传染病咨询。
ObjectivesTo analyze risk factors for early and late mortality in individuals aged 75 and older with Staphylococcus aureus bacteremia (SAB) in Italy.DesignFour-year retrospective observational study (January 2011-December 2014).SettingTwo tertiary care university hospitals in Italy (Santa Maria Misericordia Hospital in Udine, Policlinico Universitario Agostino Gemelli in Rome).ParticipantsAll adults consecutively admitted with SAB.MeasurementsClinical presentation, infection characteristics, and clinical outcomes of individuals aged 75 and older were compared with those of individuals younger than 75.ResultsThree hundred thirty-seven cases of SAB were diagnosed during the study period, 118 of which (35%) occurred in those aged 75 and older. Seven- (20.3% vs 9.2%) and 30-day (35.7% vs 20.7%) mortality were significantly higher in elderly than younger adults. Clinical presentation with septic shock, adequacy of empiric antibiotic treatment, and liver cirrhosis were found to be predictors of 7-day mortality in elderly adults with SAB. Risk factors independently associated with 30-day mortality included isolation of methicillin-resistant Staphylococcus aureus (MRSA) and not receiving an infectious disease consultation.ConclusionMortality is significantly higher in elderly than in younger adults with SAB, particularly in those presenting with septic shock, liver cirrhosis, or SAB due to MRSA. Additional risk factors for mortality included inappropriate empiric antibiotic treatment and not receiving an infectious disease consultation.