[Bacteremia in very elderly patients: risk factors, clinical characteristics and mortality].
BACKGROUND
There is little information on bacteremia in very elderly patients. This study describes the characteristics of bacteremia in this population.


METHODS
This is a prospective study investigating bacteremia episodes in patients over 80 years old in comparison with episodes in patients aged 18-64 and 65-79 years.


RESULTS
A total of 146 bacteremia episodes were analyzed in patients over 80 years old. Comorbidity was documented in 66.4% and immunodeficiency in 6.8% of patients. Among the total, 82.2% had no underlying disease or a disease considered non-fatal. Eighty episodes were community-acquired. The main infectious foci included primary (25.3%) and urinary tract (20.5%) infection, and the most frequent isolates were Escherichia coli (28.2%), coagulase-negative Staphylococcus (14.7%) and S. aureus (13.6%). Sepsis or septic shock occurred in 55.5% of the cases, and 31 patients died due to a bacteremia-related cause. Immunodeficiency was less frequent in patients over 80 years old, but they had a higher proportion of community-acquired infections and gram-negative infections. Bacteremia-related mortality was highest in the oldest group of patients and was associated with a fatal or ultimately fatal underlying disease, S. aureus infection, and inappropriate empirical antibiotic treatment. A lower Pitt severity score was related to lower mortality risk.


CONCLUSIONS
Very elderly bacteremic patients showed a lower frequency of immunodeficiency, a higher percentage of community-acquired and gram-negative infections. Bacteremia-related mortality was greater in the most elderly group and was associated with fatal or ultimately fatal underlying disease, S. aureus infection and initiation of inappropriate empirical antibiotic treatment.
Unidad de Medicina Interna, Hospital Son Llàtzer, Palma de Mallorca, Spain. apayeras@hsll.es
Antoni
A
Payeras
Mercedes
M
García-Gasalla
Margarita
M
Garau
Marta
M
Juan I Roca
Antonio
A
Pareja
Carmen
C
Cifuentes
Francisco
F
Homar
Carmen
C
Gallegos
Antonio
A
Bassa
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000276:immunology / Q000401:mortality; D017714:Community-Acquired Infections / Q000453:epidemiology; D004198:Disease Susceptibility; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000276:immunology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000276:immunology; D017052:Hospital Mortality; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000453:epidemiology / Q000276:immunology; D013030:Spain / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology