title: Systemic inflammatory response syndrome in nosocomial bloodstream infections with Pseudomonas aeruginosa and Enterococcus Species: comparison of elderly and nonelderly patients.
abstract: OBJECTIVE
  To determine whether the systemic inflammatory response syndrome (SIRS), clinical course, and outcome of monomicrobial nosocomial bloodstream infection (BSI) due to Pseudomonas aeruginosa or Enterococcus spp. is different in elderly patients than in younger patients.
  
  
  METHODS
  Historical cohort study.
  
  
  METHODS
  An 820-bed tertiary care facility.
  
  
  METHODS
  One hundred twenty-seven adults with P. aeruginosa or enterococcal BSI.
  
  
  METHODS
  SIRS scores were determined 2 days before the first positive blood culture through 14 days afterwards. Elderly patients (> or =65, n=37) were compared with nonelderly patients (<65, n=90). Variables significant for predicting mortality in univariate analysis were entered into a logistic regression model.
  
  
  RESULTS
  No difference in SIRS was detected between the two groups. No significant difference was noted in the incidence of organ failure, 7-day mortality, or overall mortality between the two groups. Univariate analysis revealed that Acute Physiology And Chronic Health Evaluation (APACHE) II score of 15 or greater at BSI onset; adjusted APACHE II score (points for age excluded) of 15 or greater at BSI onset; and respiratory, cardiovascular, renal, hematological, and hepatic failure were predictors of mortality. Age, sex, use of empirical antimicrobial therapy, and infection with imipenem-resistant P. aeruginosa or vancomycin-resistant enterococci did not predict mortality. Multivariate analysis revealed that hematological failure (odds ratio (OR)=8.1, 95% confidence interval (CI)=2.78-23.47), cardiovascular failure (OR=4.7, 95% CI=1.69-13.10), and adjusted APACHE II > or = 15 at BSI onset (OR=3.1, 95% CI=1.12-8.81) independently predicted death.
  
  
  CONCLUSIONS
  Elderly patients did not differ from nonelderly patients with respect to severity of illness before or at the time of BSI. Elderly patients with pseudomonal or enterococcal BSIs did not have a greater mortality than nonelderly patients.
authors.affiliation: Division of Infectious Diseases, Universidade Federal de São Paulo/Hospital São Paulo, São Paulo, Brazil. a.marra@uol.com.br
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Marra
authors.forename: Katharine
authors.initials: K
authors.lastname: Bar
authors.forename: Gonzalo M L
authors.initials: GM
authors.lastname: Bearman
authors.forename: Richard P
authors.initials: RP
authors.lastname: Wenzel
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
mesh_terms: D000367:Age Factors; D000368:Aged; D016470:Bacteremia / Q000150:complications* / Q000401:mortality / Q000628:therapy; D003422:Critical Care; D016983:Enterococcus; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011552:Pseudomonas Infections / Q000150:complications* / Q000401:mortality / Q000628:therapy; D018746:Systemic Inflammatory Response Syndrome / Q000382:microbiology* / Q000401:mortality / Q000628:therapy