Bacteremia is an important clinical problem in the elderly and is a major factor contributing to the high morbidity and mortality attributable to infections diseases in the geriatric population. In order to examine these issues in the elderly, we
reviewed the clinical course and factors involved in the outcome of 54 episodes of bacteremia in patients over 65 years of age. The emergency department charts, hospital records and microbiology reports of 54 patients with a positive blood
culture
result during the period January 1991 to December 1992 were reviewed. Place of residence before hospital admission, source of bloodstream infection, and microorganism were analyzed. Antimicrobial therapy was defined as appropriate if initial
therapy
included one agent to which the isolate was sensitive. The following factors affecting mortality were analyzed: age, sex, underlying diseases, clinical parameters on admission, source of infection, microorganism isolated, and appropriate versus
inappropriate antibiotic therapy.
Most patients were female (61 percent), febrile (85 percent), tachypheic (98 percent), and had a neutrophilic response (65 percent). Gram-negative organisms accounted for 61 percent of isolates, with Escherichia coli (41 percent); 33 percent were
gram-positive organisms, with Staphylococcus aureus (134 percent) the common. The overall mortality was 28 percent; mortality was greatest in patients whose source of bacteremia was respiratory tract infection (67 percent). Several factors were
associated with increased mortality: inappropriate therapy, age greater than 75 years old, S. aureus infection, respiratory tract infection, and the severity of underlying disease.
The data suggest that initial empiric antimicrobial therapy in the elderly be broad in scope and include coverage for S. aureus.
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