Ackermann R J, Monroe P W
Department of Family and Community Medicine, Mercer University School of Medicine, Macon, Georgia, USA.
J Am Geriatr Soc. 1996 Aug;44(8):927-33. doi: 10.1111/j.1532-5415.1996.tb01862.x.
To describe patients with bacteremic urinary tract infections, compare characteristics of young and older patients, and suggest appropriate empiric antibiotic therapy for this clinical condition.
Case series, with an observation period of 3 years.
A large southeastern community hospital.
One hundred eighty patients more than 18 years old (101 older than age 65) with urine and blood cultures simultaneously positive for bacterial organisms.
Chart review-determined demographic characteristics, clinical data, bacterial organism and antibiotic susceptibility, number of medical diagnoses, use of a urinary catheter, admission source, and mortality.
The 180 patients experienced bacteremias caused by 183 bacterial organisms. Sixty-one patients were aged 65 to 79 years, and 40 were 80 years of age or older; 63.9% of patients were female; 62.2% were black. Gram-negative organisms accounted for 80.3% of bacterial isolates, with Escherichia coli accounting for 54.1% of cases. Gram-positive organisms accounted for 19.7% of isolates, including Staphylococcus aureus (13.1%) and Enterococcus (5.5%). Older patients had a distribution of Gram-positive and Gram-negative organisms similar to that of younger patients. Men and patients with chronic urinary catheters had higher proportions of Gram-positive organisms and non-E. coli Gram-negative rods. Organisms showed excellent susceptibilities to commonly used antibiotics. In-hospital mortality was 16.1%, with higher mortality in patients with chronic urinary catheters, in patients who were admitted from nursing homes, and when a Gram-positive organism was identified. Advanced age was not associated with higher mortality.
Concomitant illness and especially the use of urethral catheters, but not advanced age itself, are associated with a higher mortality from bacteremic urinary tract infection. Single agent empiric antimicrobial therapy such as ceftriaxone may be appropriate in older patients with presumed urosepsis, except in catheterized patients or those with other risk factors for Gram-positive or resistant Gram-negative infections.
描述菌血症性尿路感染患者，比较年轻患者和老年患者的特征，并针对此临床情况提出合适的经验性抗生素治疗方案。
病例系列研究，观察期为3年。
东南部一家大型社区医院。
180例年龄超过18岁（101例年龄大于65岁）的患者，其尿液和血液培养同时检出细菌。
通过查阅病历确定人口统计学特征、临床资料、细菌种类及抗生素敏感性、医疗诊断数量、导尿管使用情况、入院来源及死亡率。
180例患者发生了由183种细菌引起的菌血症。61例患者年龄在65至79岁之间，40例患者年龄在80岁及以上；63.9%的患者为女性；62.2%为黑人。革兰阴性菌占分离出细菌的80.3%，其中大肠杆菌占病例的54.1%。革兰阳性菌占分离菌的19.7%，包括金黄色葡萄球菌（13.1%）和肠球菌（5.5%）。老年患者革兰阳性菌和革兰阴性菌的分布与年轻患者相似。男性和使用慢性导尿管的患者革兰阳性菌及非大肠杆菌革兰阴性杆菌的比例较高。这些细菌对常用抗生素表现出良好的敏感性。住院死亡率为16.1%，使用慢性导尿管的患者、从养老院入院的患者以及检出革兰阳性菌的患者死亡率较高。高龄与较高死亡率无关。
合并疾病尤其是导尿管的使用，而非高龄本身，与菌血症性尿路感染的较高死亡率相关。对于疑似尿脓毒症的老年患者，单药经验性抗菌治疗如头孢曲松可能是合适的，但导尿患者或有革兰阳性菌或耐药革兰阴性菌感染其他危险因素的患者除外。
