Bacteraemia in the very old. Features and treatment

Bacteraemia is a common disorder in the elderly, and its prevalence and incidence increase with age. It carries a mortality rate of 20 to 40%. The signs and symptoms of bacteraemia are often blunted or nonspecific in the elderly, and the index of suspicion should therefore be high. Comparing underlying disorders of bacteraemia between older and younger patients, the percentage of past cerebrovascular accidents, dementia and decubitus ulcer increases sharply with age, while the percentage of neutropenia is lower. Elderly patients have a predilection for anaerobic bloodstream infections, and for multiresistant bacteria, although age is not an independent risk factor for resistance. Bacterial endocarditis in the old is caused mainly by gut bacteria. Appropriate empirical antibiotic treatment reduces mortality, regardless of age. To target antibiotic treatment, the physician should consider the patient's salient features, and the overall susceptibility of the micro-organisms in the local ecosystem. The most important supportive measure for treatment of sepsis or septic shock is fluid repletion. No non-antibiotic drug has been shown to be effective in sepsis.