Bacteremic urinary tract infection in older people
Bacteremic urinary tract infection in older people
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DOI：
10.1111/j.1532-5415.1996.tb01862.x
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发表时间：
1996-08-01
影响因子：
6.3
通讯作者：
Monroe, PW
中科院分区：
文献类型：
--
作者：
Ackermann, RJ;Monroe, PW
目的：描述细菌性尿路感染的患者，比较年轻患者和老年患者的特点，并建议针对这种临床情况进行适当的经验性抗生素治疗。设计：病例系列，观察期3年。集合：东南部一家大型社区医院。对象：180例18岁以上(101例65岁以上)尿和血培养同时呈细菌培养阳性的患者。测量：图表回顾-确定的人口学特征，临床资料，细菌和抗生素敏感性，医疗诊断的数量，使用尿管，入院来源和死亡率。结果：180例患者经历了183种细菌引起的细菌感染。61名患者年龄在65岁至79岁之间，40名患者年龄在80岁或以上；63.9%的患者是女性；62.2%的患者是黑人。革兰氏阴性菌占80.3%，其中大肠埃希菌占54.1%。革兰阳性菌占分离菌株的19.7%，其中金黄色葡萄球菌占13.1%，肠球菌占5.5%。老年患者的革兰氏阳性菌和革兰氏阴性菌的分布与年轻患者相似。男性和有慢性导尿管的患者革兰氏阳性菌比例较高，非E。革兰氏阴性杆菌。生物体对常用抗生素表现出极好的敏感性。住院死亡率为16.1%，在慢性导尿管患者、从疗养院住院的患者以及当发现革兰氏阳性菌时，死亡率较高。结论：伴发疾病，尤其是导尿管的使用，而不是高龄本身，与细菌性尿路感染的高死亡率有关。单一药物经验性抗菌治疗，如头孢曲松，可能适合于推定为尿毒症的老年患者，但留置尿管的患者或具有革兰氏阳性或耐药革兰氏阴性感染其他危险因素的患者除外。
OBJECTIVES: To describe patients with bacteremic urinary tract infections, compare characteristics of young and older patients, and suggest appropriate empiric antibiotic therapy for this clinical condition.DESIGN: Case series, with an observation period of 3 years.SETTING: A large southeastern community hospital.PARTICIPANTS: One hundred eighty patients more than 18 years old (101 older than age 65) with urine and blood cultures simultaneously positive for bacterial organisms.MEASUREMENTS: Chart review-determined demographic characteristics, clinical data, bacterial organism and antibiotic susceptibility, number of medical diagnoses, use of a urinary catheter, admission source, and mortality.RESULTS: The 180 patients experienced bacteremias caused by 183 bacterial organisms. Sixty-one patients were aged 65 to 79 years, and 40 were 80 years of age or older; 63.9% of patients were female; 62.2% were black. Gram-negative organisms accounted for 80.3% of bacterial isolates, with Escherichia coli accounting for 54.1% of cases. Grampositive organisms accounted for 19.7% of isolates, including Staphylococcus aureus (13.1%) and Enterococcus (5.5%). Older patients had a distribution of Gram-positive and Gram-negative organisms similar to that of younger patients. Men and patients with chronic urinary catheters had higher proportions of Gram-positive organisms and non-E. coli Gram-negative rods. Organisms showed excellent susceptibilities to commonly used antibiotics. In-hospital mortality was 16.1%, with higher mortality in patients with chronic urinary catheters, in patients who were admitted from nursing homes, and when a Gram-positive organism was identified. Advanced age was not associated with higher mortality.CONCLUSIONS: Concomitant illness and especially the use of urethral catheters, but not advanced age itself, are associated with a higher mortality from bacteremic urinary tract infection. Single agent empiric antimicrobial therapy such as ceftriaxone may be appropriate in older patients with presumed urosepsis, except in catheterized patients or those with other risk factors for Gram-positive or resistant Gram-negative infections.