Bacteremia In Elderly Patients Research Articles

Diagnostic accuracy of presepsin in predicting bacteraemia in elderly patients admitted to the emergency department: prospective study in Japan

ObjectiveEarly prediction of bacteraemia in the elederly is needed in the emergency department (ED).Design, setting and participantsA prospective study in Japan; single-centre trial in patients who satisfied the sepsis criteria...

Neutropenia febril in the elderly: focus on bacteriemia

Background: Febrile neutropenia (FN) represents an infectious urgency in cancer patients, mainly in those with chemotherapy treatment. Bacteremia is the most important cause of severe infections and responsible for significant morbidity and mortality. Currently evidence-based data for NF management in elderly patients is scarce because of the underrepresentation in studies. We present the analysis of a cohort of elderly population in a reference center. The aim of this study was to describe characteristics and prognosis of bacteremia in elderly patients with FN. Methods & Materials: We conducted a descriptive, retrospective study including all cancer patients with FN, aged ≥65 years, admitted between 2014-2016. Clinical and epidemiological variables of FN events with bacteremia were reviewed and analyzed: microbiological isolates, antimicrobial resistance and mortality. The X2 test was used as a statistical method (p < 0.05). Results: We evaluated 71 episodes of FN corresponded to 47 patients, with an average age of 72 (±6,49) years. 84% had a diagnosis of oncohematological disease, being acute myeloid leukemia (47%) the most frequent. The 30-day overall mortality was 29.57%. 22 episodes (31%) were culture-positive for bacteriemia. Of this, 64% were hospital-acquired infection with a median of 7.5 (7.5-14) days of hospitalization from the day of admission to the FN episode. The most common pathogens isolated were gram negative bacilli (GNB) in 68% (n:15/22) (K pneumoniae 42%), followed by gram positive cocci (GPC) with 28% (n:6/22) (S. epidermidis 83%). Methicillin resistance was found in 67% of GPC, and 40% of GNB expressed ESBL production. No statistically significant associations were found in antimicrobial resistance of isolated microorganisms between hospital-acquired and community-acquired infections (test X2 = 0.10, p = 0.74). Four patients (18%) died within 14 days after bacteremia onset. Conclusion: In this study, mortality rate in patients with FN and bacteremia were found to be similar to the published in the literature, whereas the overall mortality rate of NF events was higher. The importance of knowing the profiles of antimicrobial resistance within the institution allows us to adapt medical effort to the integral approach of this entity. This first approach opens questions that deserve the continuity of the study to clarify them.

First report of neonatal bacteraemia caused by blaNDM-1 Raoultella ornithinolytica

Raoultella ornitholytica, an environmental organism, has only recently been reported as a cause of infections in humans, and is associated mainly with bacteraemia in elderly patients. Carbapenem resistance is unusual in Raoultella spp. We describe the first paediatric case of blaNDM-1 Raoultella ornitholytica bacteraemia in a preterm neonate that developed three days after hospitalisation. This case report discusses a rare organism that had an unexpected susceptibility profile and caused bacteraemia in a neonate. Treatment options are explored.

Tri-bundles for PICC Insertion: Prevention of PICC Related Complications

The clinical effect of bacteremia on outcomes in urinary tract infection (UTI) is still debated. This study aims to examine the clinical effect of bacteremia in elderly patients with UTI requiring hospital admission.This retrospective observational study recorded the clinical features, microbiology and outcomes in a Spanish cohort of patients aged ≥65 years hospitalized for UTI in whom blood cultures were performed in the emergency department. The primary outcome of the study was in-hospital mortality.Of 333 patients, with a mean age of 81.6 years, 137 (41.1%) had positive blood cultures. Escherichia coli, with 223 (66.9%) cases, was the most common microorganism isolated. Independent risk factors of bacteremia were temperature >38°C, heart rate >90 bpm and inversely both Enterococcus faecalis and Pseudomonas aeruginosa. Bacteremia was not associated with the length of stay in hospital (6.96 ± 3.50 days versus 7.33 ± 5.54 days, P = 0.456). Mortality rate was 9.3% with no significant difference between bacteremic and nonbacteremic cases (8.8% and 9.7%, respectively, P = 0.773). In-hospital mortality analyzed by logistic regression was associated with McCabe index >2 (20.5% survival versus 66.7% death, adjusted odds ratio = 6.31, 95% CI: 2.71-14.67; P < 0.001) but not with bacteremia (41.4% survival versus 38.7% death, adjusted odds ratio = 0.99, 95% CI: 0.43-2.29; P = 0.992).Our study suggests that the presence or absence of bacteremia in elderly people with UTI requiring hospitalization does not have an influence on outcomes such as in-hospital mortality or length of stay.

First report of neonatal bacteraemia caused byblaNDM-1Raoultella ornithinolytica

Raoultella ornitholytica, an environmental organism, has only recently been reported as a cause of infections in humans, and is associated mainly with bacteraemia in elderly patients. Carbapenem resistance is unusual in Raoultella spp. We describe the first paediatric case of blaNDM-1 Raoultella ornitholytica bacteraemia in a preterm neonate that developed three days after hospitalisation. This case report discusses a rare organism that had an unexpected susceptibility profile and caused bacteraemia in a neonate. Treatment options are explored.

Effect of Bacteremia in Elderly Patients With Urinary Tract Infection

IntroductionThe clinical effect of bacteremia on outcomes in urinary tract infection (UTI) is still debated. This study aims to examine the clinical effect of bacteremia in elderly patients with UTI requiring hospital admission. MethodsThis retrospective observational study recorded the clinical features, microbiology and outcomes in a Spanish cohort of patients aged ≥65 years hospitalized for UTI in whom blood cultures were performed in the emergency department. The primary outcome of the study was in-hospital mortality. ResultsOf 333 patients, with a mean age of 81.6 years, 137 (41.1%) had positive blood cultures. Escherichia coli, with 223 (66.9%) cases, was the most common microorganism isolated. Independent risk factors of bacteremia were temperature >38°C, heart rate >90bpm and inversely both Enterococcus faecalis and Pseudomonas aeruginosa. Bacteremia was not associated with the length of stay in hospital (6.96 ± 3.50 days versus 7.33 ± 5.54 days, P = 0.456). Mortality rate was 9.3% with no significant difference between bacteremic and nonbacteremic cases (8.8% and 9.7%, respectively, P = 0.773). In-hospital mortality analyzed by logistic regression was associated with McCabe index >2 (20.5% survival versus 66.7% death, adjusted odds ratio = 6.31, 95% CI: 2.71-14.67; P < 0.001) but not with bacteremia (41.4% survival versus 38.7% death, adjusted odds ratio = 0.99, 95% CI: 0.43-2.29; P = 0.992). ConclusionsOur study suggests that the presence or absence of bacteremia in elderly people with UTI requiring hospitalization does not have an influence on outcomes such as in-hospital mortality or length of stay.

Review of bacteraemia in elderly patients in a District General Hospital in the United Kingdom

Objective.– To determine the value of procalcitonin (PCT) as a prognostic biomarker in elderly patients with respiratory infection comparing it with Curb-65 and acute phase reactants: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)and leukocytes. Methods.– Prospective observational study in elderly patients admitted to an Acute Geriatric Unit with the diagnosis of upper respiratory infection or pneumonia. We collected sociodemographic variables, clinical and geriatric assessment. Samples were taken to determine PCT, CRP and ESR at admission and 72hours after. Results.– We included 50 patients, 30 with pneumonia and 20 with respiratory infection, with an average age of 86 years, significant comorbidity (Charlson Index≥3 in more than 50%), cognitive impairment (70%) and poor functional status (Katz≥D 56%). Mortality during admission was high (37% in pneumonia and 25% in upper respiratory infection). At admission 60% of patients have elevated PCT (≥0.25ng/mL), 100% PCR, 84% ESR and 36% leukocytes. In all patients the PCT difference between admission and 72hours was marginal (P=0.059); in patients with respiratory infection decreased significantly at 72hours (P=0.046),while there wasnovariation inpatientswithpneumonia. Theother acutephase reactants, except leukocytes (P≤0.05) showedno significant differences during the first 72hours. Conclusions.– In elderly patients with suspected upper respiratory infection, decreased procalcitonin levels at 72hours indicates a good prognosis. In those with pneumonia study these evolutionary parameters at 72hours show no change, so control should be delayed.

Non-typhoidal Salmonella bacteraemia in elderly patients: an increased risk for endovascular infections, osteomyelitis and mortality

Non-typhoidal Salmonella (NTS) is a common pathogen causing foodborne infections, bacteraemia, and extra-intestinal focal infections (EFIs) in humans. The study compares the clinical characteristics of elderly patients with NTS bacteraemia with those of young adults. Of 272 adults with NTS bacteraemia identified in this study, 162 (59·6%) were aged ⩾55 years. EFIs were observed in 36% of the 162 patients. The most common EFIs in the elderly patients (⩾55 years) was mycotic aneurysm, followed by pulmonary infections and bone/joint infections. Elderly patients more often had chronic heart, lung, renal and malignant diseases, had more EFIs, and a higher 30-day mortality rate. Independent factors of 30-day mortality in elderly patients were solid-organ tumour [adjusted odds ratio (aOR) 4·4, P=0·003], mycotic aneurysm (aOR 3·7, P=0·023) and shock (aOR 12·1, P<0·0001). HIV infection, autoimmune diseases, and receipt of immunosuppressive therapy were more often observed in young patients.

Diagnostic Value of Procalcitonin for Bacterial Infection in Elderly Patients in the Emergency Department

To evaluate the diagnostic performance of procalcitonin (PCT) in elderly patients with bacterial infection in the emergency department (ED). Prospective. ED of a tertiary care hospital. Elderly patients with systemic inflammatory response syndrome (SIRS) enrolled from September 2004 through August 2005. A serum sample for the measurement of PCT, two sets of blood cultures, and other cultures of relevant specimens from infection sites were collected in the ED. Two independent experts blinded to the PCT results classified the patients into bacterial infection and nonbacterial infection groups. Of the 262 patients with SIRS enrolled, 204 were classified as having bacterial infection and 48 as having bacteremia. PCT levels were significantly higher in patients with bacteremia than in those without. The area under the receiver operating characteristic curve for identification of bacteremia according to PCT was 0.817 for the old-old group (>or=75), significantly higher than 0.639 for the young-old group (65-74); P=.02). The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of PCT for bacteremia in patients aged 75 and older were 96.0%, 68.3%, 33.8%, and 98.8%, respectively, with a PCT cutoff value of 0.38 ng/mL. PCT is sensitive for diagnosing bacteremia in elderly patients with SIRS at ED admission but is helpful in excluding bacteremia only in those aged 75 and older. PCT is not an independent predictor of local infections in these patients.

Short‐term mortality of bacteraemia in elderly patients with haematological malignancies

Bacterial infections are important complications in patients with haematological malignancies. We compared the outcome of bacteraemia among elderly and younger patients with haematological malignancies, and evaluated the impact of comorbidity on this association using population-based registries from 1992 to 2002. Among 358 patients with an incident haematological malignancy and an episode of bacteraemia, 207 (58%) were older than 60 years and 37 (10%) older than 80 years. The 7-d mortality was 10% among patients younger than 60 years, 21% among patients aged 60-79 years, and 27% for patients older than 80 years. When compared with patients younger than 60 years, the adjusted mortality rate ratios (MRRs) were 1.9 [95% confidence interval (CI): 0.9-3.8] for patients aged 60-79 years and 1.6 (95% CI: 0.6-4.2) for patients older than 80 years. The 30-d mortality was 23% among patients younger than 60 years of age, 35% among patients aged 60-79 years, and 54% among patients 80 years or older. Adjusted MRRs were 1.7 (95% CI: 1.1-2.7) and 2.3 (95% CI: 1.2-4.3), respectively. We found that increasing age was associated with increased mortality from bacteraemia in patients with haematological malignancies. An increased burden of comorbidity among the elderly did not explain this association.

Group B streptococcus bacteremia in nonpregnant adults.

We report the largest series of group B streptococcal (GBS) bacteremia cases reported at a single institution. During a 10-year period (1985-1994), 90 GBS bacteremia cases (0.95% of significant bacteremic episodes) were detected. We describe the 51 episodes that occurred in nonpregnant adults for which enough clinical and microbiological information is available. Incidence of GBS has significantly increased during the study period (from 0.08 per 1000 admissions in 1985 to 0.3 per 1000 in 1994). Mean age of patients was 63.3 years (range, 21-88 years) and 53% were men. The most common underlying conditions were liver diseases (35.3%), malignancies (33.3%), and diabetes mellitus (27.5%). Only 2 patients did not have any underlying condition and no patient with the human immunodeficiency virus had GBS bacteremia in our series. The origins of the episodes of bacteremia were as follows: primary bacteremia (39.2%), skin and soft tissue infections (15.7%), urinary tract infections (11.8%), pneumonia (9.8%), peritonitis (9.8%), catheter infection (5.9%), postendoscopic bacteremia (5.9%), and endocarditis (2%). All isolates were susceptible to penicillin G potassium, ampicillin sodium, cephalothin sodium, cefotaxime sodium, and vancomycin hydrochloride. One ciprofloxacin hydrochloride-resistant strain was discovered and resistance to erythromycin stearate increased from 8% in 1992 to 18% in 1994. The overall mortality rate was 33.3% and deaths were considered related to the GBS bacteremia in 25.5% of the cases. Factors for poor prognosis were central nervous system diseases, alcoholism, shock, renal failure, and consciousness impairment. Group B streptococcus is a rising cause of bacteremia in elderly patients with severe underlying conditions. It conveys high morbidity and mortality rates. Macrolides should not be used empirically for treatment of patients with penicillin allergies.

Difficulty in predicting bacteremia in elderly emergency patients

To characterize the clinical presentation and identify factors predictive of bacteremia in elderly patients. Retrospective review of emergency department charts, hospital records, and microbiology reports. Community teaching hospital with annual ED census of 65,000 adults. Seven hundred fifty elderly patients (aged 65 to 99 years) who were evaluated by the emergency physician, had blood cultures obtained in the ED, and were hospitalized with a suspected infectious process during a 12-month period. Records were analyzed for demographic information, underlying diseases, clinical presentation, laboratory findings, sources of infection, and causative organisms. Using contingency tables, 79 patients with positive blood cultures were compared with a random sample of 136 patients with sterile blood cultures to identify clinical variables significantly (P less than .05) associated with bacteremia. Logistic regression analysis was performed with significant factors to develop a model to predict bacteremia. Sensitivity, specificity, and predictive values were calculated for the model. The prevalence of bacteremia was 10.6%. Escherichia coli was the most commonly isolated pathogen (29% of cases), and the urinary tract was the most common source of infection (44.3% of cases). Logistic regression analysis showed that altered mental status (odds ratio, 2.88; 95% confidence interval [Cl], 1.52 to 5.50), vomiting (odds ratio, 2.63; 95% Cl, 1.16 to 6.15), and WBC band forms of more than 6% (0.06) (odds ratio, 3.50; 95% Cl, 1.58 to 5.27) were independent predictors of bacteremia. The presence of at least one of these three factors had a sensitivity of 0.85 (95% Cl, 0.75 to 0.92) and a specificity of 0.46 (95% Cl, 0.38 to 0.55) for predicting bacteremia in the study group. The positive predictive value was 0.16 (95% Cl, 0.12 to 0.19) and the negative predictive value was 0.96 (95% Cl, 0.94 to 0.98) for the ED patient group that met inclusion criteria. Elderly patients fail to manifest identifiable clinical features indicative of bloodstream infection. The sensitivity and specificity of the best statistical model for identifying bacteremic elderly patients suggest that clinical indicators alone are unreliable predictors of bacteremia in the geriatric ED population studied.

Gram-negative bacillary bacteremia in the elderly: incidence, ecology, etiology, and mortality.

The incidence, ecology, and mortality of gram-negative bacillary bacteremia in elderly patients were studied in an analysis of 334 episodes over a four-year-period in a 489-bed North Carolina community teaching hospital, 135 (40.4%) of which occurred in patients 70 years of age or older. The bacteremia rate per 1000 hospital admissions increased sharply with increasing age. The ecology and in vitro antimicrobial susceptibilities of the bacterial isolates were strongly influenced by community v hospital acquisition, but not by age. Urosepsis was significantly more likely to be the underlying source of hospital-acquired bacteremia in patients 70 years or older (P less than 0.01). Total bacteremia-related mortality did not increase with increasing age; in the group of patients aged 70 years or older with nonfatal/ultimately fatal underlying diseases (NF/UFUD), however, mortality was 9.1% compared to 2.9% in the younger age group (P less than 0.001). Significantly increased bacteremia-related mortality was also noted in the older patients with NF/UFUD admitted from nursing homes (P less than 0.05) and those not treated with an appropriate antimicrobial agent within 24 hours (P less than 0.01). Overall, the older patients with hospital-acquired bacteremia, neutropenia-associated infection, those bacteremic from a nonurinary source of infection, and those treated with multiple-drug regimens had higher mortality (P less than 0.05). Gram-negative bacteremia is much more common in patients 70 years of age or older and compared with younger patients mortality appears to be significantly increased for the important subgroup of older patients with nonfatal or ultimately fatal underlying diseases.

Bacteremia in a Long-term Care Facility

One hundred episodes of bacteremia were studied in a primarily geriatric population. Gram-positive bacteremia accounted for 24% of all bacteremia (50% mortality rate), while gram-negative bacteremia accounted for 67% of bacteremia (25% mortality); 9% of all bacteremias were polymicrobial in nature (67% mortality). Overall mortality was 35%. The urinary tract was the most frequently identified tissue source (56%) followed by skin and subcutaneous tissue (14%) and respiratory tract (10%). Escherichia coli, Proteus species, and Klebsiella enterobacter group were the most common gram-negative organisms, Staphylococcus aureus was the most common gram-positive organism and together they accounted for approximately 75% of all bacteremia. Fifty percent of deaths occurred within 24 hours of diagnosis of bacteremia, despite appropriate antibiotic therapy. This study may help to identify risk factors for bacteremia in elderly patients.

Community-Acquired Bacteremic Urosepsis in the Elderly Patients: A Prospective Study of 34 Consecutive Episodes

A prospective study was done on the clinical, laboratory, radiological, immunological and therapeutic features of acute, symptomatic, bacteremic urosepsis in 34 consecutive, elderly patients who required hospitalization. Urinary tract infection was identified as the most common cause of gram-negative bacteremia in elderly patients admitted to a community hospital. Appropriate antibiotic therapy and a lack of serious associated medical illnesses contributed to the high survival rate.Bacteremia and shock occurring in the wake of pyelonephritis develop more commonly in elderly than in young women. In the elderly patient with bacteremia and pyelonephritis radiographic evaluation invariably demonstrates obstruction to urine flow, calculous disease or abscess. Guidelines are provided for the therapy of acute, symptomatic bacteremic urosepsis.

Acute pyelonephritis in the elderly.

We did a prospective study of the clinical, laboratory, radiologic, and therapeutic features of acute, symptomatic, bacterial pyelonephritis in 35 consecutive elderly, noncatheterized patients who required hospitalization. Pyelonephritis had been identified as the most common cause of gram-negative bacteremia in elderly patients admitted to a community hospital. Appropriate antibiotic therapy and, of equal importance, a lack of serious associated medical illnesses contributed to the 97% survival. Two features appear to distinguish acute, symptomatic, bacterial pyelonephritis in elderly women from that in young women: an increased incidence of bacteremia and septic shock. We provide guidelines for the diagnostic evaluation and antibiotic therapy of acute, symptomatic, community-acquired, bacterial pyelonephritis in the elderly.