Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan.
Am J Emerg Med. 2013 Feb;31(2):282-90. doi: 10.1016/j.ajem.2012.07.024. Epub 2012 Sep 20.
To investigate the clinical impact of age on bacteremia among adults visiting the emergency department (ED).
Bacteremic adults visiting the ED from January 2008 to December 2008 were identified retrospectively. Demographic characteristics, severity, bacteremic pathogens with in vitro susceptibility, antimicrobial agents, and outcomes determined from chart records were analyzed as a case-control study.
Of 518 eligible bacteremic adults, 288 (55.6%) elderly patients (≥65 years old) were case patients and 230 younger patients (<65 years) were regarded as control patients. The 28-day mortality rate was higher in the case patients than that in the control patients (11.8% vs 6.1%, P = .02). The proportion of inappropriate empirical antibiotic therapy between the survivors and nonsurvivors was similar in control patients (69.4% vs 64.3%, P = .77); but for the case patients, the proportion of inappropriate empirical antibiotic therapy in the survivors was lower than that in the non-survivors (27.6% vs 44.1%, P = .04). Of note, inappropriate empirical antibiotic therapy was also one of independent risk factors of 28-day mortality by the multivariate analyses in the case patients (odds ratio [OR] 3.65; P = .049). Other independent predictors of 28-day mortality in case patients included a high Pittsburgh bacteremia score (≥4 points; OR 22.16; P < .001), bacteremia due to foci other than urinary tract infection (OR 9.07; P = .002), malignancy (OR 10.87; P < .001), coronary artery disease (OR 5.68; P = .01), and high serum creatinine (>1.5 mg/dL; OR 3.44; P = .04).
For bacteremic adults, this study demonstrated the impact of inappropriate empirical antibiotic therapy on patients' outcome in the elderly was greater than that in the younger adults.
调查年龄对急诊科就诊成年人菌血症的临床影响。
本研究采用回顾性病例对照研究方法，分析了 2008 年 1 月至 2008 年 12 月期间因菌血症就诊于急诊科的成年患者的临床资料。从病历记录中分析患者的人口统计学特征、严重程度、体外药敏试验的菌血症病原体、抗菌药物和预后。
在 518 例符合条件的菌血症成年患者中，288 例（55.6%）老年患者（≥65 岁）为病例患者，230 例年轻患者（<65 岁）为对照患者。病例患者的 28 天死亡率高于对照患者（11.8%比 6.1%，P=0.02）。在对照患者中，存活者和死亡者之间经验性抗生素治疗不当的比例相似（69.4%比 64.3%，P=0.77）；但对于病例患者，存活者中经验性抗生素治疗不当的比例低于死亡者（27.6%比 44.1%，P=0.04）。多变量分析表明，经验性抗生素治疗不当也是病例患者 28 天死亡率的独立危险因素之一（比值比[OR]3.65；P=0.049）。病例患者 28 天死亡率的其他独立预测因素包括高匹兹堡菌血症评分（≥4 分；OR 22.16；P<0.001）、非尿路感染病灶引起的菌血症（OR 9.07；P=0.002）、恶性肿瘤（OR 10.87；P<0.001）、冠心病（OR 5.68；P=0.01）和高血清肌酐（>1.5 mg/dL；OR 3.44；P=0.04）。
对于菌血症成年人，本研究表明经验性抗生素治疗不当对老年患者的影响大于年轻患者。
