Bacteremia in a multilevel geriatric hospital

Bloodstream infection (BSI) is a major cause of morbidity and mortality in hospitals. Bacteremia in the elderly remains a diagnostic as well as a therapeutic challenge to the clinician.

We investigate the clinical features, microbiological characteristics, and outcome of bacteremic episodes in a mixed LTC elderly population in a multilevel geriatric hospital. Data of patients with the diagnosis of BSI (during 2 years) was collected retrospectively from the records of the bacteriology laboratory of a 400-bed multilevel geriatric hospital.

During the 2 years of the study period, 3453 blood cultures have been performed; 368 positive blood cultures (10%) were detected in 309 patients. The total mortality rate at 2 weeks was 42%. One quarter of the deaths occurred in the first 3 days of the septic event (rapidly fatal period). Escherichia coli was the most common isolate (detected in 31% of cases). The second most common isolates were Staphylococcus aureus (19%; 63% of them MRSA) with a mortality of 39% and Proteus mirabilis (18%) with a 51% mortality rate. Urinary tract infection was the leading cause (70%), followed by decubitus ulcers (25%) and respiratory tract infections (12%).

the number of elderly skilled patients with severe and complex conditions in LTC facilities is increasing and more infections complicated by bacteremia are expected, requiring high clinical suspicion, close surveillance, and adequate reporting.