title: Predictors of early mortality in very elderly patients with bacteremia: a prospective multicenter cohort.
abstract: OBJECTIVE
  The proportion of very elderly people in the population is increasing, and infectious diseases in this patient group may present with specific characteristics. The objective of this study was to investigate the outcome predictors of bacteremia among the very elderly.
  
  
  METHODS
  This was a multicenter prospective cohort study of bloodstream infections (BSI) in patients ≥ 80 years old in 15 hospitals in Spain. The outcome variables were 14-day and 30-day mortality. Multivariate analysis was performed.
  
  
  RESULTS
  One hundred and twenty episodes were included. Mortality was 22% (n = 26) on day 14 and 28% (n = 34) on day 30. In the univariate analysis, the variables associated with mortality were neutropenia, recent surgery, Pitt score ≥ 2, intensive care unit (ICU) admission, severe sepsis or shock, and abdominal, unknown, and respiratory tract sources. In the multivariate analysis, variables associated with mortality on day 14 were high-risk source (abdominal, unknown, and respiratory tract sources; odds ratio (OR) 7.9, 95% confidence interval (CI) 1.8-33.9), Pitt score ≥ 2 (OR 5.6, 95% CI 1.3-23.3), inadequate empirical treatment (OR 11.24, 95% CI 1.6-80.2), and severe sepsis or shock at presentation (OR 5.3, 95% CI 1.4-20.7); the interaction between empiric treatment and high-risk source was significant. On day 30, mortality was independently related to a high-risk source (OR 2.92, 95% CI 1.1-7.5) and presentation with severe sepsis or shock (OR 3.81, 95% CI 1.2-12.4).
  
  
  CONCLUSIONS
  Presentation with severe sepsis or shock and a high-risk source of BSI were independent predictors of 14-day and 30-day mortality. Inadequate empirical treatment was also a predictor of early mortality in patients with a high-risk source.
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain; Red Española de Investigación en Patología Infecciosa, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: pilaretamar@hotmail.com.
authors.forename: Pilar
authors.initials: P
authors.lastname: Retamar
authors.affiliation: Unidad Clínica de Microbiología y Enfermedades Infecciosas, Hospital del SAS, Jerez de la Frontera, Cádiz, Spain.
authors.forename: María Dolores
authors.initials: MD
authors.lastname: López-Prieto
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rodríguez-López
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: de Cueto
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
authors.forename: María V
authors.initials: MV
authors.lastname: García
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Seville, Spain.
authors.forename: Verónica
authors.initials: V
authors.lastname: González-Galan
authors.affiliation: Unidades de Enfermedades Infecciosas, Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Del Arco
authors.affiliation: Servicio de Microbiología, Hospital de la Serranía, Ronda, Málaga, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Pérez-Santos
authors.affiliation: Unidad de Enfermedades Infecciosas, Hospital de La Línea, Cádiz, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Téllez-Pérez
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Punta de Europa, Algeciras, Cádiz, Spain.
authors.forename: Berta
authors.initials: B
authors.lastname: Becerril-Carral
authors.affiliation: Servicio de Medicina Interna, Hospital Puerta del Mar, Cádiz, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Martín-Aspas
authors.affiliation: Unidad de Enfermedades Infecciosas y Microbiología, Complejo Hospitalario de Jaén, Jaén, Spain.
authors.forename: Ascensión
authors.initials: A
authors.lastname: Arroyo
authors.affiliation: Unidad Clínica de Microbiología y Enfermedades Infecciosas, Hospital del SAS, Jerez de la Frontera, Cádiz, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Pérez-Cortés
authors.affiliation: Servicio de Microbiología, Hospital de Antequera, Málaga, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Acosta
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Seville, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Florez
authors.affiliation: Sección de Enfermedades Infecciosas, Hospital Torrecárdenas, Almería, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: León-Ruiz
authors.affiliation: Unidad de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Granada, Spain.
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Muñoz-Medina
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain; Red Española de Investigación en Patología Infecciosa, Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, University of Seville, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez-Baño
mesh_terms: D000369:Aged, 80 and over; D016470:Bacteremia / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies
keywords: Bacteremia; Mortality; Very elderly