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.
Unidad Clínica de Microbiología y Enfermedades Infecciosas, Hospital del SAS, Jerez de la Frontera, Cádiz, Spain.
Int J Infect Dis. 2014 Sep;26:83-7. doi: 10.1016/j.ijid.2014.04.029. Epub 2014 Jul 5.
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.
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.
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).
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.
人口中超龄老人的比例正在增加，此类患者群体中的传染病可能具有特定特征。本研究旨在调查高龄人群菌血症的预后预测因子。
这是一项在西班牙 15 家医院开展的针对 80 岁以上人群血流感染（BSI）的多中心前瞻性队列研究。结局变量为 14 天和 30 天死亡率。进行了多变量分析。
共纳入 120 例病例。第 14 天死亡率为 22%（n=26），第 30 天死亡率为 28%（n=34）。单变量分析中，与死亡率相关的变量包括中性粒细胞减少症、近期手术、Pitt 评分≥2、入住重症监护病房（ICU）、严重脓毒症或休克，以及腹部、未知和呼吸道来源。多变量分析中，与第 14 天死亡率相关的变量包括高危源（腹部、未知和呼吸道来源）、Pitt 评分≥2（OR 7.9，95%CI 1.8-33.9）、经验性治疗不充分（OR 11.24，95%CI 1.6-80.2），以及就诊时出现严重脓毒症或休克（OR 5.3，95%CI 1.4-20.7）；经验性治疗和高危源之间的交互作用具有统计学意义。第 30 天，死亡率与高危源（OR 2.92，95%CI 1.1-7.5）和就诊时出现严重脓毒症或休克（OR 3.81，95%CI 1.2-12.4）独立相关。
就诊时出现严重脓毒症或休克和高危源的 BSI 是 14 天和 30 天死亡率的独立预测因子。高危源患者经验性治疗不充分也是早期死亡的预测因子。
