Predictors of early mortality in very elderly patients with bacteremia: a prospective multicenter cohort
Objectives: 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...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2014-09-01
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| Series: | International Journal of Infectious Diseases |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971214015264 |
| _version_ | 1828411169187037184 |
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| author | Pilar Retamar María Dolores López-Prieto Fernando Rodríguez-López Marina de Cueto María V. García Verónica González-Galan Alfonso del Arco María J. Pérez-Santos Francisco Téllez-Pérez Berta Becerril-Carral Andrés Martín-Aspas Ascensión Arroyo Salvador Pérez-Cortés Federico Acosta Carmen Florez Laura León-Ruiz Leopoldo Muñoz-Medina Jesús Rodríguez-Baño |
| author_facet | Pilar Retamar María Dolores López-Prieto Fernando Rodríguez-López Marina de Cueto María V. García Verónica González-Galan Alfonso del Arco María J. Pérez-Santos Francisco Téllez-Pérez Berta Becerril-Carral Andrés Martín-Aspas Ascensión Arroyo Salvador Pérez-Cortés Federico Acosta Carmen Florez Laura León-Ruiz Leopoldo Muñoz-Medina Jesús Rodríguez-Baño |
| author_sort | Pilar Retamar |
| collection | DOAJ |
| description | Objectives: 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. |
| first_indexed | 2024-12-10T12:24:51Z |
| format | Article |
| id | doaj.art-184ec13ae8c64bf3a455c50340dd3373 |
| institution | Directory Open Access Journal |
| issn | 1201-9712 1878-3511 |
| language | English |
| last_indexed | 2024-12-10T12:24:51Z |
| publishDate | 2014-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-184ec13ae8c64bf3a455c50340dd33732022-12-22T01:48:58ZengElsevierInternational Journal of Infectious Diseases1201-97121878-35112014-09-0126C838710.1016/j.ijid.2014.04.029Predictors of early mortality in very elderly patients with bacteremia: a prospective multicenter cohortPilar Retamar0María Dolores López-Prieto1Fernando Rodríguez-López2Marina de Cueto3María V. García4Verónica González-Galan5Alfonso del Arco6María J. Pérez-Santos7Francisco Téllez-Pérez8Berta Becerril-Carral9Andrés Martín-Aspas10Ascensión Arroyo11Salvador Pérez-Cortés12Federico Acosta13Carmen Florez14Laura León-Ruiz15Leopoldo Muñoz-Medina16Jesús Rodríguez-Baño17Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, SpainUnidad Clínica de Microbiología y Enfermedades Infecciosas, Hospital del SAS, Jerez de la Frontera, Cádiz, SpainUnidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Reina Sofía, Córdoba, SpainUnidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, SpainUnidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de la Victoria, Málaga, SpainUnidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Seville, SpainUnidades de Enfermedades Infecciosas, Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, SpainServicio de Microbiología, Hospital de la Serranía, Ronda, Málaga, SpainUnidad de Enfermedades Infecciosas, Hospital de La Línea, Cádiz, SpainUnidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Punta de Europa, Algeciras, Cádiz, SpainServicio de Medicina Interna, Hospital Puerta del Mar, Cádiz, SpainUnidad de Enfermedades Infecciosas y Microbiología, Complejo Hospitalario de Jaén, Jaén, SpainUnidad Clínica de Microbiología y Enfermedades Infecciosas, Hospital del SAS, Jerez de la Frontera, Cádiz, SpainServicio de Microbiología, Hospital de Antequera, Málaga, SpainUnidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Seville, SpainSección de Enfermedades Infecciosas, Hospital Torrecárdenas, Almería, SpainUnidad de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Granada, SpainUnidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, SpainObjectives: 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.http://www.sciencedirect.com/science/article/pii/S1201971214015264BacteremiaMortalityVery elderly |
| spellingShingle | Pilar Retamar María Dolores López-Prieto Fernando Rodríguez-López Marina de Cueto María V. García Verónica González-Galan Alfonso del Arco María J. Pérez-Santos Francisco Téllez-Pérez Berta Becerril-Carral Andrés Martín-Aspas Ascensión Arroyo Salvador Pérez-Cortés Federico Acosta Carmen Florez Laura León-Ruiz Leopoldo Muñoz-Medina Jesús Rodríguez-Baño Predictors of early mortality in very elderly patients with bacteremia: a prospective multicenter cohort International Journal of Infectious Diseases Bacteremia Mortality Very elderly |
| title | Predictors of early mortality in very elderly patients with bacteremia: a prospective multicenter cohort |
| title_full | Predictors of early mortality in very elderly patients with bacteremia: a prospective multicenter cohort |
| title_fullStr | Predictors of early mortality in very elderly patients with bacteremia: a prospective multicenter cohort |
| title_full_unstemmed | Predictors of early mortality in very elderly patients with bacteremia: a prospective multicenter cohort |
| title_short | Predictors of early mortality in very elderly patients with bacteremia: a prospective multicenter cohort |
| title_sort | predictors of early mortality in very elderly patients with bacteremia a prospective multicenter cohort |
| topic | Bacteremia Mortality Very elderly |
| url | http://www.sciencedirect.com/science/article/pii/S1201971214015264 |
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