COMMUNITY-ACQUIRED BACTEREMIA IN THE ELDERLY - A PROSPECTIVE-STUDY OF 121 CASES

Objective: To describe community-acquired bacteremia in the elderly and correlate clinical and laboratory findings with outcome. Design: Prospective study of consecutive cases. Setting: Large community-based teaching hospital. Patients: One hundred and twenty-one elderly patients aged 65 to 89 years, seen between February 1, 1986 and January 31, 1988. Main Outcome Measures: Bacteriological cultures, symptoms and signs, laboratory findings, and mortality. Results: Gram-negative organisms accounted for 65 (54%) cases and Gram-positive organisms for 47 (39%) cases, while nine (7%) cases were polymicrobial, E. coli (39%), Klebsiella sp. (8%), S. pneumoniae (14%), and S. aureus (12%) were the most commonly isolated organisms. The overall mortality was 38%. A poor prognosis was associated with confusion as a presenting symptom (P < 0.0003), hypotension (P < 0.0003), and inappropriate or delayed treatment (P < 0.02). A good prognosis was associated with E. coli as the pathogen (P < 0.0003) and prompt, appropriate antibiotic therapy. Conclusion: Community-acquired bacteremia in the elderly has a high mortality rate. Early recognition and prompt, appropriate treatment are critical in reducing the mortality.