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

Alexandre R Marra; Katharine Bar; Gonzalo M L Bearman; Richard P Wenzel; Michael B Edmond

doi:10.1111/j.1532-5415.2006.00698.x

Back

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

Journal article

Peer reviewed

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

Alexandre R Marra, Katharine Bar, Gonzalo M L Bearman, Richard P Wenzel and Michael B Edmond

Journal of the American Geriatrics Society, Vol.54(5), pp.804-808

05/2006

DOI: 10.1111/j.1532-5415.2006.00698.x

PMID: 16696747

View Online

Abstract

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. Historical cohort study. An 820-bed tertiary care facility. One hundred twenty-seven adults with P. aeruginosa or enterococcal BSI. SIRS scores were determined 2 days before the first positive blood culture through 14 days afterwards. Elderly patients (> or =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. 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. Multivariate analysis revealed that hematological failure (odds ratio (OR)=8.1, 95% confidence interval (CI)=2.78-23.47), cardiovascular failure (OR=4.7, 95% CI=1.69-13.10), and adjusted APACHE II > or = 15 at BSI onset (OR=3.1, 95% CI=1.12-8.81) independently predicted death. 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.

Enterococcus

Length of Stay

Gram-Positive Bacterial Infections - therapy

Age Factors

Hospital Mortality

Outcome Assessment (Health Care)

Systemic Inflammatory Response Syndrome - microbiology

Humans

Middle Aged

Bacteremia - complications

Gram-Positive Bacterial Infections - mortality

Pseudomonas Infections - therapy

Pseudomonas Infections - complications

Bacteremia - mortality

Male

Pseudomonas Infections - mortality

Systemic Inflammatory Response Syndrome - therapy

Bacteremia - therapy

Critical Care

Female

Aged

Gram-Positive Bacterial Infections - complications

Systemic Inflammatory Response Syndrome - mortality

Details

Title: Subtitle: Systemic inflammatory response syndrome in nosocomial bloodstream infections with Pseudomonas aeruginosa and Enterococcus Species: comparison of elderly and nonelderly patients
Creators: Alexandre R Marra - Division of Infectious Diseases, Universidade Federal de São Paulo/Hospital São Paulo, São Paulo, Brazil. a.marra@uol.com.br
Katharine Bar
Gonzalo M L Bearman
Richard P Wenzel
Michael B Edmond
Resource Type: Journal article
Publication Details: Journal of the American Geriatrics Society, Vol.54(5), pp.804-808
Publisher: United States
DOI: 10.1111/j.1532-5415.2006.00698.x
PMID: 16696747
ISSN: 0002-8614
eISSN: 1532-5415
Language: English
Date published: 05/2006
Academic Unit: Infectious Diseases; Internal Medicine
Record Identifier: 9983905649002771

Metrics

35 Record Views

15 Times Cited - Web of Science