Systemic inflammatory response syndrome in nosocomial bloodstream infections with Pseudomonas aeruginosa and Enterococcus species: Comparison of elderly and nonelderly patients

Systemic inflammatory response syndrome in nosocomial bloodstream infections with Pseudomonas aeruginosa and Enterococcus species: Comparison of elderly and nonelderly patients

Autor Marra, A. R. Google Scholar
Bar, K. Google Scholar
Bearman, GML Google Scholar
Wenzel, R. P. Google Scholar
Edmond, M. B. Google Scholar
Instituição Universidade Federal de São Paulo (UNIFESP)
Virginia Commonwealth Univ
Resumo OBJECTIVES: To determine whether the systemic inflammatory response syndrome (SIRS), clinical course, and outcome of monomicrobial nosocomial bloodstream infection (BSI) due to Pseudomonas aeruginosa or Enterococcus spp. is different in elderly patients than in younger patients.DESIGN: Historical cohort study.SETTING: An 820-bed tertiary care facility.PARTICIPANTS: One hundred twenty-seven adults with P. aeruginosa or enterococcal BSI.MEASUREMENTS: SIRS scores were determined 2 days before the first positive blood culture through 14 days afterwards. Elderly patients (>= 65, n = 37) were compared with nonelderly patients (< 65, n = 90). Variables significant for predicting mortality in univariate analysis were entered into a logistic regression model.RESULTS: No difference in SIRS was detected between the two groups. No significant difference was noted in the incidence of organ failure, 7-day mortality, or overall mortality between the two groups. Univariate analysis revealed that Acute Physiology and Chronic Health Evaluation (APACHE) II score of 15 or greater at BSI onset; adjusted APACHE II score (points for age excluded) of 15 or greater at BSI onset; and respiratory, cardiovascular, renal, hematological, and hepatic failure were predictors of mortality. Age, sex, use of empirical antimicrobial therapy, and infection with imipenem-resistant P. aeruginosa or vancomycin-resistant enterococci did not predict mortality. Multivarlate analysis revealed that hematological failure (odds ratio (OR) = 8.1, 95% confidence interval (CI) = 2.78-23.47), cardiovascular failure (OR = 4.7, 95% Cl = 1.69-13.1.0), and adjusted APACHE 11 >= 15 at BSI onset (OR = 3.1, 95% CI = 1.12-8.81) independently predicted death.CONCLUSION: Elderly patients did not differ from nonelderly patients with respect to severity of illness before or at the time of BSI. Elderly patients with pseudomonal or enterococcal BSIs did not have a greater mortality than nonelderly patients.
Palavra-chave elderly patients
SIRS
bloodstream infection
Pseudomonas aeruginosa
Enterococcus spp.
Idioma Inglês
Data de publicação 2006-05-01
Publicado em Journal of the American Geriatrics Society. Oxford: Blackwell Publishing, v. 54, n. 5, p. 804-808, 2006.
ISSN 0002-8614 (Sherpa/Romeo, fator de impacto)
Publicador Blackwell Publishing
Extensão 804-808
Fonte http://dx.doi.org/10.1111/j.1532-5415.2006.00698.x
Direito de acesso Acesso restrito
Tipo Artigo
Web of Science WOS:000237531900011
Endereço permanente http://repositorio.unifesp.br/handle/11600/28904

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