Bacteriemias y fungemiasepidemiología, etiología, manifestaciones clínicas y adecuación terapéutica según grupos de edad

Resumen

Introduction. There are few studies comparing epidemiology, etiology, clinical characteristics, as well as therapeutic adequacy among adult, older adults and elderly patients in bacteremia. Patients and Methods. Retrospective observational study conducted at Gómez Ulla Hospital between February 2016 and February 2017. All patients >14 years old who were admitted (> 24 hours of hospitalization) with compatible clinic bacteremia, fungemia and with microbiologically significant blood culture were included. Patients were divided into 3 groups according to age range: adults (<65 years), older adults (65-84 years) and elderly (≥ 85 years). Epidemiological, etiological and clinical data were analyzed, as well as mortality. The groups were compared using the chi-square test or the variance test (ANOVA). Survival was analyzed by the Kaplan-Meier method and the Cox regression model. Results. Four hundred and twenty-five types of bacteremia were included and six fungemia. The incidence was 34.4 per 1,000 admissions. Of whom 19.5% were adults (<65 years), 51.5% older adults (65-84 years) and 29% elderly (≥85 years). Forty-four percent of adults had received prior antibiotic treatment, 33% of older adults had an onco-hematological disease and 39% of the elderly had dementia. In both adults and older adults, nosocomial bacteremia was the most frequent (50% and 51%, respectively), while community-acquired bacteremia was in the elderly (37%). Catheter-associated bacteremia was the most frequent origin in adults (31%) and bacteremia secondary to urinary infection in older adults and elderly patients (31 and 33%, respectively). Gram-positive bacteria were the most prevalent etiology in adults (65%) and the elderly (59%), while in the case of older adults Gram-positive and Gram-negative bacteria were isolated in a similar percentage (47% vs 42 %). A significantly higher percentage of multi-resistant microorganisms were isolated among the oldest patients (p = 0.023). There was a similar percentage of sepsis and septic shock in all age groups (p = 0.533). Regarding treatment, the elderly received a significantly higher percentage of inadequate empirical treatments (38%, p = 0.044). Twenty-one percent of the patients died, mostly elderly (42%). Conclusions. There was a significantly higher percentage of multi-resistant microorganisms, inadequate empirical treatments and mortality among elderly patients.