Gram‐Negative Bacillary Bacteremia in the Elderly: Incidence, Ecology, Etiology, and Mortality

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Abstract
The incidence, ecology, and mortality of gram-negative bacillary bacteremia in elderly patients were studied in an analysis of 334 episodes ovar a four-year-period in a 489-bed North Carolina community teaching hospital, 135 (40.4%) of which occurred in patients 70 years of age or older. The bacteremia rate per 1000 hospital admissions increased sharply with increasing age. The ecology and in vitro antimicrobial susceptibilties of the bacterial isolates were strongly influenced by community v hospital acquisition, but not by age. Urosepsis was significantly more likely to be the underlying source of hospital-acquired bacteremia in patients 70 years or older (P < 0.01). Total bacteremia-related mortality did not increase with increasing age; in the group of patients age 70 years or older with nonfatal/ultimately fatal underlying diseases (NF/UFUD), however, mortality was 9.1% compared to 2.9% in the younger age group (P < 0.001). Significantly increased bacteremia-related mortality was also noted in the older patients with NF/UFUD admitted from nursing homes (P < 0.05) and those not treated with an appropriated antimicrobial agent within 24 hours (P < 0.01). Overall, the older patients with hospital-acquired bacteremia, neutropenia-associated infection, those bacteremic from a nonurinary source of infection, and those treated with multiple-drug regimens had higher mortality (P < 0.05). Gram-negative bacteremia is much more common in patients 70 years of age or older and compared with younger patients mortality appears to be significantly increased for the important subgroup of older patients with nonfatal or ultimately fatal underlying diseases.