UROSEPSIS IN THE ELDERLY - CLINICAL AND MICROBIOLOGIC CHARACTERISTICS

We reviewed 105 patients age 65 or older who were admitted with ''uros epsis,'' which we defined as urinary tract infection plus at least one of the following: fever (temperature >38-degrees-C), hypothermia (tem perature <35.5-degrees-C), hypotension (systolic blood pressure <90 mm Hg), or change in mental status. Blood cultures were positive in 50%; bacteremia was predicted only by the presence of hypotension (P < .05 ), but this sign was not sensitive enough to exclude bacteremia in pat ients without hypotension. One hundred (95%) were infected with a gram -negative rod; of these, 53 were Escherichia coli, of which 12 (22%) w ere resistant to ampicillin. Of the 47 non-E. coli gram-negative rods, 26 (56%) were ampicillin resistant. Sixteen of the 100 gram-negative rods were resistant to multiple antibiotics. Stepwise logistic regress ion analysis showed recent hospital admission and nursing home residen ce to be independent predictors of infection with multiply resistant g ram-negative rods (P < .01). No factors were predictive of infection w ith ampicillin-resistant gram-negative rods. We conclude that bacterem ia and resistance to ampicillin were common and unpredictable in elder ly patients admitted with urosepsis but that a subset of patients at r isk for multiply resistant gram-negative rods may be identified at the time of admission.