title: Clinical characteristics, treatment and outcomes of MRSA bacteraemia in the elderly.
abstract: OBJECTIVE
  To compare clinical and microbiological characteristics, treatment and outcomes of MRSA bacteraemia among elderly and younger patients.
  
  
  METHODS
  Prospective study conducted at 21 Spanish hospitals including patients with MRSA bacteraemia diagnosed between June/2008 and December/2009. Episodes diagnosed in patients aged 75 or more years old (≥75) were compared with the rest of them (<75).
  
  
  RESULTS
  Out of 579 episodes of MRSA bacteraemia, 231 (39.9%) occurred in patients ≥75. Comorbidity was significantly higher in older patients (Charlson score ≥4: 52.8 vs. 44%; p = .037) as was the severity of the underlying disease (McCabe ≥1: 61.9 vs. 43.4%; p < .001). In this group the acquisition was more frequently health-care related (43.3 vs. 33.9%, p = .023), mostly from long-term care centers (12.1 vs. 3.7%, p < .001). An unknown focus was more frequent among ≥75 (19.9 vs. 13.8%; p = .050) while severity at presentation was similar between groups (Pitt score ≥3: 31.2 vs. 27.6%; p = .352). The prevalence of vancomycin resistant isolates was similar between groups, as was the appropriateness of empirical antibiotic therapy. Early (EM) and overall mortality (OM) were significantly more frequent in the ≥75 group (EM: 12.1 vs. 6%; p = .010 OM: 42.9 vs. 23%; p < .001). In multivariate analysis age ≥75 was an independent risk factor for overall mortality (aOR: 2.47, CI: 1.63-3.74; p < .001).
  
  
  CONCLUSIONS
  MRSA bacteraemia was frequent in patients aged ≥75 of our cohort. This group had higher comorbidity rates and the source of infection was more likely to be unknown. Although no differences were seen in severity or adequacy of empiric therapy, elderly patients showed a higher overall mortality.
authors.affiliation: Department of Infectious Diseases, H. Bellvitge, Barcelona, Spain. Electronic address: guillermocuervo@hotmail.com.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Cuervo
authors.affiliation: Department of Infectious Diseases, H. Parc Taulí, Sabadell, Spain. Electronic address: oriol.gasch@gmail.com.
authors.forename: Oriol
authors.initials: O
authors.lastname: Gasch
authors.affiliation: Department of Infectious Diseases, H. Bellvitge, Barcelona, Spain. Electronic address: evelyn.shaw@bellvitgehospital.cat.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Shaw
authors.affiliation: Department of Microbiology, H. Bellvitge, Barcelona, Spain. Electronic address: mcamoez@bellvitgehospital.cat.
authors.forename: Mariana
authors.initials: M
authors.lastname: Camoez
authors.affiliation: Department of Microbiology, H. Bellvitge, Barcelona, Spain. Electronic address: adominguez@bellvitgehospital.cat.
authors.forename: María Ángeles
authors.initials: MÁ
authors.lastname: Domínguez
authors.affiliation: Department of Infectious Diseases, H. Gregorio Marañón, Madrid, Spain. Electronic address: belenpadilla@telefonica.net.
authors.forename: Belén
authors.initials: B
authors.lastname: Padilla
authors.affiliation: Department of Infectious Diseases, H. Ramón y Cajal, Madrid, Spain. Electronic address: vicente.pintado@salud.madrid.org.
authors.forename: Vicente
authors.initials: V
authors.lastname: Pintado
authors.affiliation: Department of Infectious Diseases, H. Vall d'Hebrón, Barcelona, Spain. Electronic address: balmirante@vhebron.net.
authors.forename: Benito
authors.initials: B
authors.lastname: Almirante
authors.affiliation: Department of Infectious Diseases, H. Virgen del Rocío, Sevilla, Spain. Electronic address: josea.lepe.sspa@juntadeandalucia.es.
authors.forename: José A
authors.initials: JA
authors.lastname: Lepe
authors.affiliation: Department of Infectious Diseases, H. 12 de Octubre, Madrid, Spain. Electronic address: flmedrano@yahoo.es.
authors.forename: Francisco
authors.initials: F
authors.lastname: López-Medrano
authors.affiliation: Department of Microbiology, H. Son Espases, Palma de Mallorca, Spain. Electronic address: enrique.ruiz@ssib.es.
authors.forename: Enrique
authors.initials: E
authors.lastname: Ruiz de Gopegui
authors.affiliation: Department of Infectious Diseases, H. Clìnic, Barcelona, Spain. Electronic address: jamarti@clinic.ub.es.
authors.forename: José A
authors.initials: JA
authors.lastname: Martínez
authors.affiliation: Department of Infectious Diseases, H. Cruces, Bilbao, Spain. Electronic address: josemiguelmontejo@hotmail.com.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Montejo
authors.affiliation: Department of Infectious Diseases, H. Reina Sofía/IMIBIC/UCO, Córdoba, Spain. Electronic address: elena.pereznadales@imibic.org.
authors.forename: Elena
authors.initials: E
authors.lastname: Perez-Nadales
authors.affiliation: Department of Microbiology, H. Marqués de Valdecilla, Santander, Spain. Electronic address: santill_ana@hotmail.com.
authors.forename: Ana
authors.initials: A
authors.lastname: Arnáiz
authors.affiliation: Department of Infectious Diseases, H. Donostia, Donostia, Spain. Electronic address: miguelangel.goenagasanchez@osakidetza.net.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Goenaga
authors.affiliation: Department of Infectious Diseases, H. de la Santa Creu i Sant Pau, Barcelona, Spain. Electronic address: nbenito@santpau.cat.
authors.forename: Natividad
authors.initials: N
authors.lastname: Benito
authors.affiliation: Department of Infectious Diseases, H. del Mar, Barcelona, Spain. Electronic address: jhorcaja@yahoo.es.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Horcajada
authors.affiliation: Department of Infectious Diseases, H. Virgen de Macarena, Sevilla, Spain. Electronic address: jesusrb@us.es.
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez-Baño
authors.affiliation: Department of Infectious Diseases, H. Bellvitge, Barcelona, Spain. Electronic address: mpujol@bellvitgehospital.cat.
authors.forename: Miquel
authors.initials: M
authors.lastname: Pujol
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology*; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology*; D016896:Treatment Outcome
keywords: Bacteraemia; Elderly; MRSA