Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA.
J Am Geriatr Soc. 2010 Feb;58(2):300-5. doi: 10.1111/j.1532-5415.2009.02666.x. Epub 2010 Jan 8.
To assess clinical outcomes and identify risk factors for mortality in older adults with Staphylococcus aureus bloodstream infection (SAB).
Retrospective review.
University of Michigan Health System, Ann Arbor.
All patients aged 80 and older with SAB between January 2004 and July 2008.
Clinical data, including comorbid conditions, SAB source, echocardiography results, Charlson Comorbidity Index, mortality (in-hospital and 6-month), and need for rehospitalization or chronic care after discharge.
Seventy-six patients aged 80 and older (mean 85.5 +/- 4.2) with SAB were identified. Infection sources included 14 (18.4%) vascular catheter associated, 16 (21.1%) wound related, seven (9.2%) endocarditis, five (6.6%) intravascular, and 19 (25%) with unknown source; 46 (60.5%) patients had methicillin-resistant strains. Twenty-two (28.9%) patients underwent surgery or device placement within 30 days of developing SAB; 10 of these 22 had SAB associated with surgical site infection (SSI). Twenty two (28.9%) patients died in the hospital or were discharged to hospice care; at least 43 (56.6%) patients died within 6 months of presentation, and eight were lost to follow-up. Unknown source of bacteremia (odds ratio=5.2, P=.008) was independently associated with in-hospital death. Echocardiography was not pursued in 45% of patients. Of surviving patients, 40 (74.1%) required skilled care after discharge; eight (20%) required rehospitalization.
SAB was associated with high mortality rates in patients aged 80 and older. The observed association between SAB and SSI may direct preventive strategies such as perioperative decolonization or antimicrobial prophylaxis. Interventions to optimize clinical care practices in elderly patients with SAB are essential given the associated morbidity and mortality.
评估老年金黄色葡萄球菌血流感染（SAB）患者的临床转归和死亡相关因素。
回顾性研究。
密歇根大学健康系统，安阿伯。
2004 年 1 月至 2008 年 7 月所有年龄 80 岁及以上的 SAB 患者。
临床数据，包括合并症、SAB 源、超声心动图结果、Charlson 合并症指数、死亡率（住院期间和 6 个月）和出院后再次住院或慢性护理需求。
共确定了 76 例年龄 80 岁及以上（平均 85.5 +/- 4.2 岁）的 SAB 患者。感染源包括 14 例（18.4%）与血管导管相关、16 例（21.1%）与伤口相关、7 例（9.2%）与心内膜炎相关、5 例（6.6%）与血管内相关和 19 例（25%）来源不明；46 例（60.5%）患者为耐甲氧西林金黄色葡萄球菌。22 例（28.9%）患者在发生 SAB 后 30 天内行手术或器械植入；22 例中 10 例与手术部位感染（SSI）相关。22 例（28.9%）患者在院内死亡或出院至临终关怀；至少 43 例（56.6%）患者在就诊后 6 个月内死亡，8 例失访。血培养源不明（比值比=5.2，P=.008）与院内死亡独立相关。45%的患者未行超声心动图检查。存活患者中，40 例（74.1%）出院后需要熟练护理；8 例（20%）需要再次住院。
年龄 80 岁及以上的 SAB 患者死亡率较高。SAB 与 SSI 之间的观察到的相关性可能指导预防性策略，如围手术期去定植或抗菌预防。鉴于相关的发病率和死亡率，对老年 SAB 患者的临床护理实践进行干预至关重要。
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