Predictors of in-hospital mortality in elderly patients with bacteraemia admitted to an Internal Medicine ward.
Predictors of in-hospital mortality in elderly patients with bacteraemia admitted to an Internal Medicine ward.
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DOI：
10.1186/1755-7682-4-33
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发表时间：
2011-10-04
期刊：
影响因子：
--
通讯作者：
Costa JN
中科院分区：
文献类型：
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作者：
Rebelo M;Pereira B;Lima J;Decq-Mota J;Vieira JD;Costa JN
感染性疾病是老年患者发病率和死亡率增加的常见原因。老年人的菌血症是一个困难的诊断和治疗的挑战，由于年龄相关的变迁和他们的合并症。这项研究的主要目的是评估住院的老年菌血症患者住院期间死亡率的独立危险因素。总体而言，回顾性研究了135例65岁及以上菌血症患者的队列。记录每例患者的人口统计学信息、合并症、入院时的临床参数、感染来源和类型、血培养中分离的微生物、实验室数据和经验性抗生素治疗相关数据。进行多变量logistic回归分析以确定全因住院死亡率的独立预测因素。在这135名患者中，45.9%为女性。该组患者最常见的感染是尿路感染（46.7%）。血培养分离出的主要微生物为大肠埃希菌（14.9%）、耐甲氧西林金黄色葡萄球菌（12.0%）、非耐甲氧西林金黄色葡萄球菌（11.4%）、肺炎克雷伯菌（9.1%）和粪肠球菌（8.0%）。住院病死率为22.2%。与住院死亡率相关的独立预后因素为年龄≥ 85岁、慢性肾脏疾病、不明病灶菌血症和入院时认知功能障碍（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]和OR，3.621 [95%CI，1.226-10.695; p = 0.020]）。通过多变量分析，适当的抗生素治疗与较低的死亡率无关。菌血症在老年人中有很高的死亡率。没有一组体征或临床特征可以预测老年人的菌血症。然而，高龄（≥ 85岁）、慢性肾脏疾病、不明病灶菌血症和重度认知障碍对内科病房收治的老年菌血症患者的结局产生不利影响。
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. 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. 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. 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.