Cargando…

Age-related differences in symptoms, diagnosis and prognosis of bacteremia

BACKGROUND: Elderly patients are at particular risk for bacteremia and sepsis. Atypical presentation may complicate the diagnosis. We studied patients with bacteremia, in order to assess possible age-related effects on the clinical presentation and course of severe infections. METHODS: We reviewed t...

Descripción completa

Detalles Bibliográficos
Autores principales: Wester, Astrid L, Dunlop, Oona, Melby, Kjetil K, Dahle, Ulf R, Wyller, Torgeir Bruun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3733624/
https://www.ncbi.nlm.nih.gov/pubmed/23883345
http://dx.doi.org/10.1186/1471-2334-13-346
_version_ 1782279373898907648
author Wester, Astrid L
Dunlop, Oona
Melby, Kjetil K
Dahle, Ulf R
Wyller, Torgeir Bruun
author_facet Wester, Astrid L
Dunlop, Oona
Melby, Kjetil K
Dahle, Ulf R
Wyller, Torgeir Bruun
author_sort Wester, Astrid L
collection PubMed
description BACKGROUND: Elderly patients are at particular risk for bacteremia and sepsis. Atypical presentation may complicate the diagnosis. We studied patients with bacteremia, in order to assess possible age-related effects on the clinical presentation and course of severe infections. METHODS: We reviewed the records of 680 patients hospitalized between 1994 and 2004. All patients were diagnosed with bacteremia, 450 caused by Escherichia coli and 230 by Streptococcus pneumoniae. Descriptive analyses were performed for three age groups (< 65 years, 65–84 years, ≥ 85 years). In multivariate analyses age was dichotomized (< 65, ≥ 65 years). Symptoms were categorized into atypical or typical. Prognostic sensitivity of CRP and SIRS in identifying early organ failure was studied at different cut-off values. Outcome variables were organ failure within one day after admission and in-hospital mortality. RESULTS: The higher age-groups more often presented atypical symptoms (p <0.001), decline in general health (p=0.029), and higher in-hospital mortality (p<0.001). The prognostic sensitivity of CRP did not differ between age groups, but in those ≥ 85 years the prognostic sensitivity of two SIRS criteria was lower than that of three criteria. Classical symptoms were protective for early organ failure (OR 0.67, 95% CI 0.45-0.99), and risk factors included; age ≥ 65 years (OR 1.65, 95% CI 1.09-2.49), comorbid illnesses (OR 1.19, 95% CI 1.02-1.40 per diagnosis), decline in general health (OR 2.28, 95% CI 1.58-3.27), tachycardia (OR 1.50, 95% CI 1.02-2.20), tachypnea (OR 3.86, 95% CI 2.64-5.66), and leukopenia (OR 4.16, 95% CI 1.59-10.91). Fever was protective for in-hospital mortality (OR 0.46, 95% CI 0.24-0.89), and risk factors included; age ≥ 65 years (OR 15.02, 95% CI 3.68-61.29), ≥ 1 comorbid illness (OR 2.61, 95% CI 1.11-6.14), bacteremia caused by S. pneumoniae (OR 2.79, 95% CI 1.43-5.46), leukopenia (OR 4.62, 95% CI 1.88-11.37), and number of early failing organs (OR 3.06, 95% CI 2.20-4.27 per failing organ). CONCLUSIONS: Elderly patients with bacteremia more often present with atypical symptoms and reduced general health. The SIRS-criteria have poorer sensitivity for identifying organ failure in these patients. Advanced age, comorbidity, decline in general health, pneumococcal infection, and absence of classical symptoms are markers of a poor prognosis.
format Online
Article
Text
id pubmed-3733624
institution National Center for Biotechnology Information
language English
publishDate 2013
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-37336242013-08-06 Age-related differences in symptoms, diagnosis and prognosis of bacteremia Wester, Astrid L Dunlop, Oona Melby, Kjetil K Dahle, Ulf R Wyller, Torgeir Bruun BMC Infect Dis Research Article BACKGROUND: Elderly patients are at particular risk for bacteremia and sepsis. Atypical presentation may complicate the diagnosis. We studied patients with bacteremia, in order to assess possible age-related effects on the clinical presentation and course of severe infections. METHODS: We reviewed the records of 680 patients hospitalized between 1994 and 2004. All patients were diagnosed with bacteremia, 450 caused by Escherichia coli and 230 by Streptococcus pneumoniae. Descriptive analyses were performed for three age groups (< 65 years, 65–84 years, ≥ 85 years). In multivariate analyses age was dichotomized (< 65, ≥ 65 years). Symptoms were categorized into atypical or typical. Prognostic sensitivity of CRP and SIRS in identifying early organ failure was studied at different cut-off values. Outcome variables were organ failure within one day after admission and in-hospital mortality. RESULTS: The higher age-groups more often presented atypical symptoms (p <0.001), decline in general health (p=0.029), and higher in-hospital mortality (p<0.001). The prognostic sensitivity of CRP did not differ between age groups, but in those ≥ 85 years the prognostic sensitivity of two SIRS criteria was lower than that of three criteria. Classical symptoms were protective for early organ failure (OR 0.67, 95% CI 0.45-0.99), and risk factors included; age ≥ 65 years (OR 1.65, 95% CI 1.09-2.49), comorbid illnesses (OR 1.19, 95% CI 1.02-1.40 per diagnosis), decline in general health (OR 2.28, 95% CI 1.58-3.27), tachycardia (OR 1.50, 95% CI 1.02-2.20), tachypnea (OR 3.86, 95% CI 2.64-5.66), and leukopenia (OR 4.16, 95% CI 1.59-10.91). Fever was protective for in-hospital mortality (OR 0.46, 95% CI 0.24-0.89), and risk factors included; age ≥ 65 years (OR 15.02, 95% CI 3.68-61.29), ≥ 1 comorbid illness (OR 2.61, 95% CI 1.11-6.14), bacteremia caused by S. pneumoniae (OR 2.79, 95% CI 1.43-5.46), leukopenia (OR 4.62, 95% CI 1.88-11.37), and number of early failing organs (OR 3.06, 95% CI 2.20-4.27 per failing organ). CONCLUSIONS: Elderly patients with bacteremia more often present with atypical symptoms and reduced general health. The SIRS-criteria have poorer sensitivity for identifying organ failure in these patients. Advanced age, comorbidity, decline in general health, pneumococcal infection, and absence of classical symptoms are markers of a poor prognosis. BioMed Central 2013-07-24 /pmc/articles/PMC3733624/ /pubmed/23883345 http://dx.doi.org/10.1186/1471-2334-13-346 Text en Copyright © 2013 Wester et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Wester, Astrid L
Dunlop, Oona
Melby, Kjetil K
Dahle, Ulf R
Wyller, Torgeir Bruun
Age-related differences in symptoms, diagnosis and prognosis of bacteremia
title Age-related differences in symptoms, diagnosis and prognosis of bacteremia
title_full Age-related differences in symptoms, diagnosis and prognosis of bacteremia
title_fullStr Age-related differences in symptoms, diagnosis and prognosis of bacteremia
title_full_unstemmed Age-related differences in symptoms, diagnosis and prognosis of bacteremia
title_short Age-related differences in symptoms, diagnosis and prognosis of bacteremia
title_sort age-related differences in symptoms, diagnosis and prognosis of bacteremia
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3733624/
https://www.ncbi.nlm.nih.gov/pubmed/23883345
http://dx.doi.org/10.1186/1471-2334-13-346
work_keys_str_mv AT westerastridl agerelateddifferencesinsymptomsdiagnosisandprognosisofbacteremia
AT dunlopoona agerelateddifferencesinsymptomsdiagnosisandprognosisofbacteremia
AT melbykjetilk agerelateddifferencesinsymptomsdiagnosisandprognosisofbacteremia
AT dahleulfr agerelateddifferencesinsymptomsdiagnosisandprognosisofbacteremia
AT wyllertorgeirbruun agerelateddifferencesinsymptomsdiagnosisandprognosisofbacteremia