title: Profile and prognosis of febrile elderly patients with bacteremic urinary tract infection.
abstract: OBJECTIVE
  To describe the profile of elderly patients with bacteremic urinary tract infections (UTI) and correlate clinical and laboratory findings with the outcome in order to identify independent predictors of mortality.
  
  
  METHODS
  This retrospective study took place in a large community-based, geriatric hospital and included 191 patients aged 75-105 years with urine and blood cultures simultaneously positive for bacterial organisms. Records were analysed for demographic information, clinical and laboratory data over a 29 month period. Mortality was assessed and was correlated with these findings.
  
  
  RESULTS
  Most of the patients (80.1%) had community-acquired infection. Gram-negative organisms accounted for 87.6% of bacterial isolates, with Escherichia coli accounting for 46.1% of cases. Non-Escherichia coli Gram-negative organisms were highly resistant to two common urinary tract antibiotics (gentamicin and ceftriaxone). Patients with chronic urinary catheter had Gram-negative bacteria significantly less sensitive to ciprofloxacin, gentamycin, ampicillin and ceftriaxon than patients without catheter (p<0.05). In-hospital mortality was 33%. Multiple logistic regression analysis revealed that mortality was significantly related to the number of underlying diagnoses (p<0.0203), cognitive status (p<0.0003), length of hospitalization (p<0.0397), low level of serum albumin (p<0.0021), high neutrophil count (p<0.0001) and high level of lactate dehydrogenase (p<0.0351). Fatality was not associated with advanced age in the very old.
  
  
  CONCLUSIONS
  Bacteremic UTI in the elderly has a high mortality rate. In frail elderly patients with age-associated multiple severe underlying disorders and cognitive impairment, early recognition of bacteremic UTI and prompt, appropriate treatment are critical in reducing the mortality.
authors.affiliation: Department of Subacute, Kaplan Medical Center, Harzfeld Geriatric Hospital, Gedera 70750, Israel. ysmg_tal@netvision.net.il
authors.forename: Sari
authors.initials: S
authors.lastname: Tal
authors.forename: Vladimir
authors.initials: V
authors.lastname: Guller
authors.forename: Shmuel
authors.initials: S
authors.lastname: Levi
authors.forename: Rita
authors.initials: R
authors.lastname: Bardenstein
authors.forename: David
authors.initials: D
authors.lastname: Berger
authors.forename: Irina
authors.initials: I
authors.lastname: Gurevich
authors.forename: Alexander
authors.initials: A
authors.lastname: Gurevich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*