BACTEREMIA IN THE ELDERLY - CLINICAL-FEAT URES AND PROGNOSTIC FACTORS

BACKGROUND: The analysis of the most relevant characteristics and prog nostic factors in elderly patients with bacteremia. PATIENTS AND METHO DS: For the period 1989-1993 a prospective study of all significant ba cteremias in adult patients admitted to a General Hospital was perform ed. Patients were visited until their death or during at least 50 days , The most relevant findings in elderly patients (over 65 years old) a re described. Overall survival probabilities were obtained by Kaplan-M eier analysis. Cox proportional models were used to examine hazards of dying. RESULTS: Of the 1,128 bacteremias studied, 608 (53.9%) were in elderly patients. In this group, the increasing age was related with higher frequency of urinary (p = 0.02) and biliary (p = 0.001) sources of infection and lower frequency of underlying neoplasia (p = 0.06), inmunosupression (p = 0.0000) and development of septic shock (p = 0.0 2). These differences are higher in patients over 85. Among older pati ents the survival probability in the day 21 after diagnosis was 0.71 ( 95% CI 0.66-0.74), significantly lower to the probability in younger p atients (p = 0.0001). In the elderly patients, the worse prognostic wa s associated to shock (RR = 8; 95% CI 5.8-11), indeterminated source o f infection (RR = 3.6; 95% CI 2.2-5.8), underlying neoplasia (RR = 1.7 ; 95% CI 1.3-2.4), neutropenia (RR = 1.5; 95% CI 1.1-2.1) nosocomial a cquisition (RR = 1.3; 95% CI 1.0-3.1) and inappropriate treatment (RR = 1.2; 95% CI 1.0-3.2), but age was not an independent contributor. Co nclusions: We found differences between the clinical characteristics a nd the prognosis of bacteremia in elderly and younger patients. Among older patients, those over 85 years old constitute a particular group with well defined characteristics.