Predictive Factors of In-Hospital Mortality in Older Adults with Community-Acquired Bloodstream Infection

Area of Science:

• Gerontology
• Infectious Diseases
• Clinical Medicine

Background:

• Bloodstream infections (BSI) pose a significant threat to older adults, a population with increased vulnerability to severe outcomes.
• Understanding the specific mortality risks and contributing factors for BSI in elderly patients (75+) is crucial for improving clinical management and patient outcomes.

Purpose of the Study:

• To determine the prevalence of in-hospital mortality among patients aged 75 and older admitted with bloodstream infections (BSI).
• To identify associated risk factors contributing to mortality in this specific elderly demographic experiencing BSI.

Main Methods:

• A single-center retrospective study was conducted at an 850-bed academic hospital.
• Data from inpatients aged 75 and older admitted with BSI between January 2015 and December 2017 were analyzed.
• Collected data included demographical, clinical, and microbiological information.

Main Results:

• The study included 212 patients (median age 82 years, 60% female) with an in-hospital mortality rate of 19%.
• Gram-negative strains, particularly Escherichia coli, were the most common pathogens, with urinary tract infections being the most frequent source of BSI.
• Non-survivors exhibited significantly higher SOFA scores, comorbidity scores, rates of respiratory and fungal infections, bedridden status, and healthcare-associated infections compared to survivors. Only SOFA score remained an independent predictor of mortality (HR 1.75).

Conclusions:

• Bloodstream infections in older adults are associated with substantial in-hospital mortality.
• The severity of the clinical presentation at onset, particularly the SOFA score, is the most critical predictor of mortality.
• Infections originating from the respiratory tract and BSI in bedridden patients indicate a higher risk of mortality.