BACTEREMIA IN ELDERLY EMERGENCY PATIENTS

Hwang, Jooil; Lee, Keejoong; Park, Kyunam; Lee, Wonjae; Oh, Dongryul; Park, Seunghyun; Kim, Sekyung

J Korean Soc Emerg Med > Volume 5(2); 1994 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 1994;5(2): 299-305.

BACTEREMIA IN ELDERLY EMERGENCY PATIENTS

Jooil Hwang, Keejoong Lee, Kyunam Park, Wonjae Lee, Dongryul Oh, Seunghyun Park, Sekyung Kim

Department of Emergency Medicine, Catholic University Medical College

Published online: December 31, 1994.

ABSTRACT

Bacteremia is an important clinical problem in the elderly and is a major factor contributing to the high morbidity and mortality attributable to infectious 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), tachypneic (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 (13 percent) the most 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 diseases. The data suggest that initial empiric antimicrobial therapy in the elderly be broad in scope and include coverage for S. aureus.