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Clinical characteristics, treatment and outcomes of MRSA bacteraemia in the elderly

2015; Elsevier BV; Volume: 72; Issue: 3 Linguagem: Inglês

10.1016/j.jinf.2015.12.009

1532-2742

Guillermo Cuervo, Oriol Gasch, Evelyn Shaw, Mariana Camoez, M.Á. Domínguez, Belén Padilla, Vicente Pintado, Benito Almirante, José Antonio Lepe, Francisco López‐Medrano, Enrique Ruíz de Gopegui, José Antonio Martínez, José Miguel Montejo, Elena Pérez‐Nadales, Ana Arnáiz, Miguel Ángel Goenaga, Natividad Benito, Juan Pablo Horcajada, Jesús Rodríguez‐Baño, Miquel Pujol, A Jover, Fernando Barroso-Barcenilla, Maria Victoria García, Miquel Pujol, Oriol Gasch, M.Á. Domínguez, Mariana Camoez, Carlos Dueñas, E. Ojeda, José Antonio Martínez, Francesc Marco, Fernando Cháves, María Lagarde, Francisco López‐Medrano, José Miguel Montejo, Elena Bereciartúa, José Luis Hernández-Davó, M. A. von Wichmann, Miguel Ángel Goenaga, J M García-Arenzana, B. Padilla, C. Padilla, Emilia Cercenado, Graciano García‐Pardo, J. Tapiol, Juan Pablo Horcajada, M. Montero, M. Salvadó, Ana Arnáiz, Camino Fernández, Esther Calbo, Mariona Xercavins, A.L. Ortega Granados, D. Fontanals, Vicente Pintado, Elena Loza, Julián Torre-Cisneros, R. Lara, Fernando Rodríguez-López, Miguel Ángel Morán Rodríguez, C. Natera, Irene Gracia-Ahufinger, José Ramón Blanco, Inés Olarte, Natividad Benito, Beatriz Mirelis, Javier Murillas, E. Ruiz de Gopegui, E. Espejo, M. Morera, Jesús Rodríguez‐Baño, Luis Eduardo López-Cortés, Álvaro Pascual, Claire Martin, José Antonio Lepe, José Molina, Roger Sordé, Benito Almirante, Nieves Larrosa,

Streptococcal Infections and Treatments

Objectives To compare clinical and microbiological characteristics, treatment and outcomes of MRSA bacteraemia among elderly and younger patients. Material and methods Prospective study conducted at 21 Spanish hospitals including patients with MRSA bacteraemia diagnosed between June/2008 and December/2009. Episodes diagnosed in patients aged 75 or more years old (≥75) were compared with the rest of them (<75). Results Out of 579 episodes of MRSA bacteraemia, 231 (39.9%) occurred in patients ≥75. Comorbidity was significantly higher in older patients (Charlson score ≥4: 52.8 vs. 44%; p = .037) as was the severity of the underlying disease (McCabe ≥1: 61.9 vs. 43.4%; p < .001). In this group the acquisition was more frequently health-care related (43.3 vs. 33.9%, p = .023), mostly from long-term care centers (12.1 vs. 3.7%, p < .001). An unknown focus was more frequent among ≥75 (19.9 vs. 13.8%; p = .050) while severity at presentation was similar between groups (Pitt score ≥3: 31.2 vs. 27.6%; p = .352). The prevalence of vancomycin resistant isolates was similar between groups, as was the appropriateness of empirical antibiotic therapy. Early (EM) and overall mortality (OM) were significantly more frequent in the ≥75 group (EM: 12.1 vs. 6%; p = .010 OM: 42.9 vs. 23%; p < .001). In multivariate analysis age ≥75 was an independent risk factor for overall mortality (aOR: 2.47, CI: 1.63–3.74; p < .001). Conclusion MRSA bacteraemia was frequent in patients aged ≥75 of our cohort. This group had higher comorbidity rates and the source of infection was more likely to be unknown. Although no differences were seen in severity or adequacy of empiric therapy, elderly patients showed a higher overall mortality.