title: Risk factors for 28-day mortality in elderly patients with extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae bacteremia.
abstract: Gram-negative bacteremia is common in elderly patients and, compared with younger patients, mortality rates in bacteremic elderly patients are high. ESBL-producing organisms were one of the most important risk factors associated with mortality. In addition, older age is one of risk factors for colonization or infection with ESBL-producing organisms. We conducted a retrospective cohort study to evaluate risk factors of all-cause 28-day mortality in elderly patients with ESBL-producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) bacteremia. Patients aged 65 years or older, who had one or more blood cultures positive for E. coli and K. pneumoniae and who were hospitalized between January 2006 and December 2010 at a tertiary-care teaching hospital, were included. 191 bacteremic elderly patients were eligible for the study. The all-cause 28-day mortality rate was 24.6% (47/191). In multivariate analysis, prior antimicrobial therapy (p=0.014) and an elevated SOFA score (p<0.001) were independent risk factors for increased mortality, while urinary tract infection (UTI) was an independent determinant for non-mortality (p=0.011). In the current study, prior antimicrobial therapy within 30 days, an elevated SOFA score and nonurinary source of infection were significantly associated with adverse outcomes in elderly patients with ESBL-producing gram-negative bacteremia.
authors.affiliation: Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Nam Su
authors.initials: NS
authors.lastname: Ku
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Kim
authors.forename: Min Hyung
authors.initials: MH
authors.lastname: Kim
authors.forename: Je Eun
authors.initials: JE
authors.lastname: Song
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Oh
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Ahn
authors.forename: Sun Bean
authors.initials: SB
authors.lastname: Kim
authors.forename: Hye-Won
authors.initials: HW
authors.lastname: Kim
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Jeong
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Han
authors.forename: Chang Oh
authors.initials: CO
authors.lastname: Kim
authors.forename: Young Goo
authors.initials: YG
authors.lastname: Song
authors.forename: June Myung
authors.initials: JM
authors.lastname: Kim
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Choi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality*; D004926:Escherichia coli / Q000201:enzymology* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000382:microbiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007710:Klebsiella Infections / Q000382:microbiology / Q000401:mortality*; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D008297:Male; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases
keywords: ESBL; Elderly patients; Gram-negative bacteremia; Mortality; Risk factor