Advanced Age is not a Risk Factor for Mortality in Patients with Bacteremia Caused by Extended-Spectrum...

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Geriatric Medicine

Background:

• Bacteremia caused by extended-spectrum β-lactamase (ESBL) producing organisms presents a significant therapeutic challenge.
• Optimal antibiotic management, particularly the use of carbapenems, in elderly patients with ESBL bacteremia requires further investigation.

Purpose of the Study:

• To evaluate the association between advanced age (≥ 85 years) and 30-day mortality in patients with ESBL-producing organism bacteremia.
• To assess carbapenem prescription patterns in different age groups within this patient population.

Main Methods:

• Retrospective cohort study involving 179 patients with ESBL bacteremia across six hospitals in Niigata, Japan.
• Propensity score matching was used to compare outcomes between patients aged 65-84 years and those aged ≥ 85 years.
• Multivariate regression analysis identified factors associated with 30-day mortality.

Main Results:

• Patients aged ≥ 85 years were more likely to receive carbapenem (89%) compared to those aged 65-84 years (61%).
• After propensity score matching, advanced age (≥ 85 years) was not significantly associated with 30-day mortality.
• Other sites of infection and biliary tract infections showed a positive association with 30-day mortality.

Conclusions:

• In patients with ESBL-producing organism bacteremia, advanced age (≥ 85 years) was not a predictor of 30-day mortality.
• Despite higher carbapenem use in the oldest patients, withholding carbapenems may be a viable strategy, warranting further clinical consideration.