Comparison of clinical manifestations and outcome of community-acquired bloodstream infections among the oldest old, elderly, and adult patients
Journal
Medicine
Journal Volume
86
Journal Issue
3
Pages
138-144
Date Issued
2007
Author(s)
Abstract
Valid studies comparing the clinical characteristics among adult, elderly, and the oldest old bacteremic patients are lacking. We conducted a prospective, observational study in the emergency department (ED) of a university medical center between June 2001 and June 2002. All patients >18 years of age who registered in the ED with a clinically significant, culture-positive, bloodstream infection (BSI) were enrolled. Patients were divided into 3 groups based on age: 1) oldest old (?85 yr), 2) elderly (65-84 yr), and 3) adult (18-64 yr). The clinical and laboratory manifestations and 30-day mortality were recorded. Group comparisons were performed using the chi-square test or analysis of variance (ANOVA) test, as indicated. Survival was analyzed using the Kaplan-Meier method and the Cox-regression model, adjusted for potential confounders.A total of 890 cases of community-acquired BSI were eligible for analysis. Compared to the adult group, both the elderly and the oldest old patients had more atypical clinical manifestations, a higher propensity to develop organ failure, and a worse prognosis. Elderly patients had significantly less tachycardia (p = 0.001), but more acute respiratory (p = 0.007) and renal failure (p = 0.037); the oldest old patients had more afebrile episodes (p = 0.006), leukocytosis (p = 0.012), and more patients developed respiratory failure (p = 0.009), acute renal failure (p = 0.011), septic shock (p = 0.022), and altered mental status (p = 0.013). Urinary tract infections were the main source of BSI for both the elderly and oldest old, while the oldest old patients had significantly more pneumonia than the elderly or adults.As a group, older patients had fewer signs and symptoms of BSI, but a higher risk of organ failure and a worse prognosis than younger patients. ? 2007 Lippincott Williams & Wilkins, Inc.
SDGs
Other Subjects
antibiotic agent; acute kidney failure; acute respiratory tract disease; adult; Aeromonas hydrophila; aged; alpha hemolytic Streptococcus; analysis of variance; article; bacteremia; blood disease; chi square test; clinical feature; communicable disease; comparative study; controlled study; emergency ward; Enterococcus faecalis; Escherichia coli; female; Gram negative bacterium; Gram positive bacterium; groups by age; high risk population; human; Kaplan Meier method; Klebsiella pneumoniae; leukocytosis; major clinical study; male; mental health; multiple organ failure; observational study; pneumonia; priority journal; prognosis; proportional hazards model; prospective study; Proteus mirabilis; Pseudomonas aeruginosa; respiratory failure; sepsis; septic shock; Staphylococcus aureus; statistical significance; survival; symptom; tachycardia; urinary tract infection; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Bacteremia; Community-Acquired Infections; Comorbidity; Emergency Service, Hospital; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Male; Middle Aged; Outcome Assessment (Health Care); Prognosis; Proportional Hazards Models; Prospective Studies; Regression Analysis; Taiwan
Type
journal article