Mortalidad y factores pronósticos en pacientes hospitalizados por bacteriemia adquirida en la comunidad

Carabaña, P Sanz; Martínez, Antonio Ramos; Vegas, Annette; Navarro, María José García; Rufo, M Linares

doi:10.4321/s0212-71992006000200004

Cited by 5 publications

(6 citation statements)

References 23 publications

(46 reference statements)

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“…In the present study appropriate antibiotic therapy was associated with decreased odds of mortality in univariated analysis but not in multivariated analysis, as it had already been reported in other series [11,40,41]. Some systematic reviews have already assessed the impact of appropriate antibiotic therapy in mortality rates in bacteremic patients [42-44].…”

Section: Discussionsupporting

confidence: 79%

Predictors of in-hospital mortality in elderly patients with bacteraemia admitted to an Internal Medicine ward

Rebelo¹,

Pereira²,

Lima³

et al. 2011

Int Arch Med

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BackgroundInfectious diseases are a common cause of increased morbidity and mortality in elderly patients. Bacteraemia in the elderly is a difficult diagnosis and a therapeutic challenge due to age-related vicissitudes and to their comorbidities. The main purpose of the study was to assess independent risk factors for in-hospital mortality among the elderly with bacteraemia admitted to an Internal Medicine Ward.MethodsOverall, a cohort of 135 patients, 65 years of age and older, with bacteraemia were retrospectively studied. Data related to demographic information, comorbidities, clinical parameters on admission, source and type of infection, microorganism isolated in the blood culture, laboratory data and empirical antibiotic treatment was recorded from each patient. Multivariate logistic regression was performed to identify independent predictors of all-cause in-hospital mortality.ResultsOf these 135 patients, 45.9% were women. The most common infections in this group of patients were urinary tract infections (46.7%). The main microorganisms isolated in the blood cultures were Escherichia coli (14.9%), Methicillin-resistant Staphylococcus aureus (MRSA) (12.0%), non-MRSA (11.4%), Klebsiella pneumoniae (9.1%) and Enterococcus faecalis (8.0%). The in-hospital mortality was 22.2%. Independent prognostic factors associated with in-hospital mortality were age ≥ 85 years, chronic renal disease, bacteraemia of unknown focus and cognitive impairment at admission (OR, 2.812 [95% CI, 1.039-7.611; p = 0.042]; OR, 6.179 [95% CI, 1.840-20.748; p = 0.003]; OR, 8.673 [95% CI, 1.557-48.311; p = 0.014] and OR, 3.621 [95% CI, 1.226-10.695; p = 0.020], respectively). By multivariate analysis appropriate antibiotic therapy was not associated with lower odds of mortality.ConclusionBacteraemia in the elderly has a high mortality rate. There are no set of signs or clinical features that can predict bacteraemia in the elderly. However, older age (≥ 85 years), chronic renal disease, bacteraemia of unknown focus and severe cognitive impairment adversely affects the outcome of elderly patients with bacteraemia admitted to an Internal Medicine ward.

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Section: Discussionsupporting

confidence: 79%

Predictors of in-hospital mortality in elderly patients with bacteraemia admitted to an Internal Medicine ward

Rebelo¹,

Pereira²,

Lima³

et al. 2011

Int Arch Med

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“…Además, estos pacientes tienen mayor riesgo de eventos de neutropenia febril, con el consiguiente aumento de la mortalidad [1][2][3][4][5][6][7]12 . Todos los factores de riesgo mencionados han sido reportados previamente 3,11,22,23 . En nuestro estudio los microorganismos gram negativos fueron los agentes etiológicos más frecuentes en ambos grupos.…”

Section: Discussionunclassified

“…En diferentes reportes se ha observado este fenómeno, y en algunos países desarrollados los gram positivos constituyen actualmente la primera causa de ITS. 5,27,28 Estos datos se repiten en estudios regionales de ITS-AC en los que Streptococcus pneumoniae y Staphylococcus aureus representan los principales microorganismos aislados 11,23 . En un estudio multicéntrico realizado en EEUU, se observó que del total de bacteriemias por Staphylococcus aureus en adultos, el 43,9% eran meticilino resistente de los cuales 77,1% eran adquiridos en la comunidad 1 .…”

Section: Discussionunclassified

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Características de las infecciones del torrente sanguíneo en pacientes adultos de dos centros de tercer nivel de Córdoba, Argentina

Saad

Baenas

Boisseau

et al. 2018

Rev Fac Cien Med Univ Nac Cordoba

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Introducción: Las infecciones del torrente sanguíneo (ITS) generan elevada morbimortalidad. Objetivo: Determinar características epidemiológicas, microbiológicas y clínicas de ITS adquiridas en la comunidad (ITS-AC) e intrahospitalarias (ITS-IH). Métodos: Se analizaron retrospectivamente eventos de bacteriemia y fungemia en dos hospitales de tercer nivel entre abril de 2009 y agosto de 2013. Resultados: Se identificaron 1150 eventos de ITS, 53% ITS-AC. El 61% de microorganismos aislados fueron gram negativos. Los patógenos más frecuentes fueron Escherichia coli en ITS-AC y Klebsiella pneumoniae en ITS-IH. Staphylococcus aureus fue el gram positivo más frecuente. Las principales comorbilidades fueron enfermedad renal (39%) y neoplasias (38%). El 26,8% de ITS fueron primarias. Los focos infecciosos más frecuentes fueron respiratorio (17%) y urinario (16,9%). Un elevado porcentaje de gram negativos en ITS-AC e ITS-IH fueron resistentes a ampicilina sulbactam (40,2% y 57,5%), cefalotina (36,7% y 46,8%), trimetoprima-sulfametoxazol (32,8% vs 35,5%) y ciprofloxacina (24,6% y 35,3%). Staphylococcus aureus meticilino resistente fue más frecuente en ITS-IH (31,4% vs 11,8%, p=0,007). Conclusiones: Las características clínicas y epidemiológicas de ITS fueron similares a las reportadas por otros estudios latinoamericanos. Pero observamos algunas diferencias en los perfiles de susceptibilidad antimicrobiana. Resaltamos la importancia de la vigilancia epidemiológica local para elegir tratamientos empíricos apropiados.

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“…Bacteraemia remains a significant cause of morbidity and mortality in hospitalised patients, despite recent advances in diagnosis and treatment strategies [13, 14]. The recognition of episodes of bacteraemia according to criteria of severity and early treatment optimisation can facilitate actions to improve final outcomes.…”

Section: Discussionmentioning

confidence: 99%

Results of an early intervention programme for patients with bacteraemia: analysis of prognostic factors and mortality

et al. 2017

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BackgroundBacteraemia is a common cause of morbidity and mortality in patients admitted to hospital. The aim of this study is to analyse the results of a two-year programme for the early optimisation of antibiotic treatment in patients admitted to the Costa del Sol Hospital (Marbella. Spain).MethodsA prospective two-year cohort study was conducted, evaluating all episodes of bacteraemia at the Costa del Sol Hospital. Epidemiological and microbiological characteristics, any modification of the initial antibiotic treatment, prognostic risk stratification, early mortality related to the episode of bacteraemia, and mortality after the seventh day, were included in the analysis.ResultsSeven hundred seventy-three episodes of bacteraemia were treated, 61.6% males and 38.4% females. The mean age was 65.2 years. The condition was most commonly acquired in the community (41.4%). The bacteraemia was most frequently urological in nature (30.5%), and E coli was the microorganism most frequently isolated (31.6%). In 51.1% of the episodes, a modification was made to optimise the treatment. In the first week, 8.2% died from bacteraemia, and 4.5% had died when they were located. The highest rates of death were associated with older patients, nosocomial acquisition, no source, McCabe score rapidly fatal, Charlson index ≥3, Pitt index ≥3 and treatment remained unmodified.ConclusionThe existence of bacteraemia control programmes and teams composed of clinicians who are experienced in the treatment of infectious diseases, can improve the disease outcome by enabling more severe episodes of bacteraemia to be recognised and their empirical treatment optimised.

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Mortalidad y factores pronósticos en pacientes hospitalizados por bacteriemia adquirida en la comunidad

Abstract: An inadequate empiric antibiotic therapy was not associated with a worse vital prognosis. Independent prognostic factors related to mortality were serum albumin concentration, the Pitt bacteremia score, and the McCabe and Jackson classification.

Cited by 5 publications

References 23 publications

Predictors of in-hospital mortality in elderly patients with bacteraemia admitted to an Internal Medicine ward

Predictors of in-hospital mortality in elderly patients with bacteraemia admitted to an Internal Medicine ward

Características de las infecciones del torrente sanguíneo en pacientes adultos de dos centros de tercer nivel de Córdoba, Argentina

Results of an early intervention programme for patients with bacteraemia: analysis of prognostic factors and mortality

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