Nosocomial bacteremia in very old patients: predictors of mortality.
OBJECTIVE
Nosocomial Bacteremia (NB) is associated with high mortality in elderly patients. To determine specific prognostic factors for 7- and 30-day mortality in elderly patients with NB, we analysed the characteristics of 62 NB patients, retrospectively.


METHODS
This retrospective study concerns 62 cases of NB diagnosed within a 3-year period in a geriatric department. Bacteremia is described according to CDC definitions. Epidemiological characteristics, co-morbidities, clinical (activities of daily living (ADL) before NB) and biological findings (neutrophil count, lymphocyte count, albuminemia before NB) were collected for each patient. A systemic clinical reaction was defined by the presence of one of the following parameters: chills, hypothermia <36 degrees C or hyperthermia >38.5 degrees C, or shock. Types of micro-organism and source of NB were also collected. All variables were analysed for mortality at day 7 (7-day mortality) and at day 30 (30-day mortality).


RESULTS
The 7-day mortality rate was 21% and the 30-day rate was 45%. In multivariate analysis, 7-day mortality was only associated with the absence of systemic clinical reaction [OR 9.7 (3.7-25.7)]. Again, in multivariate analysis, 30-day mortality was associated with an ADL score <2 [OR 8.3 (4.3-16.4)] and cocci gram positive NB [OR= 3.6 (1.9-6.9)].


CONCLUSIONS
The absence of any systemic clinical reaction as a single independent predictor for 7-day mortality suggests either a poorer immune response to nosocomial bacteremia or a delay in diagnosis. Functional status was the strongest predictor for 30-day mortality. In this population, further prospective studies need to include these factors to evaluate predictors of mortality for serious infectious diseases.
Gavazzi
Gaëtan
G
Biology of Aging Laboratory, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland. Gaetan.Gavazzi@hcuge.ch
Escobar
Philippe
P
Olive
Frédéric
F
Couturier
Pascal
P
Franco
Alain
A
D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality*; D002908:Chronic Disease; D015897:Comorbidity; D003428:Cross Infection / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality*; D005602:France / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors