Elderly Patient Bacteremia in an Intensive Care Unit

重症加護病房老年病患之菌血症探討

許文祥(Boon-Siang Khor) ； 林怡秀(Yi-Hsiu Lin) ； 葉美枝(How-Chin Liao) ； 廖浩欽(Mei-Chih Yeh) ； 吳銘斌(Ming-Pin Wu) ； 楊海(Hakim Josef) ； 曾柏昌(Po-Chang Tseng) ； 丁毅(Yih Ting) ； 廖訓禎(Shiumn-Jen Liaw)

《中華民國急救加護醫學會雜誌》 19卷2期 (2008/06) Pp. 47-56

https://doi.org/10.30018/JECCM.200806.0001

摘要

The purpose of the present study was to understand the clinical features, laboratory, bacteriology and outcomes of bacteremia in elderly patients in an intensive care unit (ICU) setting. We retrospectively analyzed patients with bacteremia aged 65 or above who were admitted to the 38-bed general ICU at Li- Shin Hospital in northern Taiwan from January 2004 through December 2005. Demographic, clinical, laboratory, microorganisms, co-morbidity and outcome data were collected for the analysis of elderly bacteremia patients upon taking blood cultures. During the study period, a total of 144 patients met the criteria, including 83 men (57.6%) and 61 women (42.4%). The mean age was 80±7.9 years (range, 65-99 years). Clinical features included sepsis in 4 patients (2.8%), severe sepsis in 30 patients (20.8%), and septic shock in 54 patients (37.5%). Twenty-two (15.3%) patients presented with fever, and 46 (31.9%) with hypothermia. The mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 23.8±9.7 (range, 6-54). The most frequently encountered comorbidities were ventilator requirement (91%), followed by acute renal failure (51.4%), and gastrointestinal bleeding (32.6%). A total of 207 microorganism isolates were identified. Aerobic gram-negative microorganisms accounted for 128 (61.8%) isolates. The most commonly isolated microorganisms were oxacillin-resistant Staphylococcus aureus (17.4%), followed by Klebsiella pneumoniae (16.4%), Escherichia coli (14%), Streptococcus species (10.6%), and Pseudomonas aeroginosa (7.7%). Forty-four patients (30.6%) received inadequate antibiotic treatment. The overall in-ICU mortality rate was 54.2%. The significant independent risk factors for mortality were hypothermia (p＜0.05), increasing APACHE II score (p＜0.01), septic shock (p＜0.001), bandemia (p＜0.05), thrombocytopenia (p＜0.05), metabolic acidosis (p＜0.001), hypoalbuminemia (p＜0.01), inadequate antibiotic treatment (p＜0.01), ventilator requirement (p＜0.001) and acute renal failure (p=0.001). The results of this study demonstrate the clinical characteristics and highlight the independent prognostic factors for elderly patients with bacteremia in the ICU.

關鍵字

菌血症 ； 老年病患 ； 重症加護病房

並列摘要

The purpose of the present study was to understand the clinical features, laboratory, bacteriology and outcomes of bacteremia in elderly patients in an intensive care unit (ICU) setting. We retrospectively analyzed patients with bacteremia aged 65 or above who were admitted to the 38-bed general ICU at Li- Shin Hospital in northern Taiwan from January 2004 through December 2005. Demographic, clinical, laboratory, microorganisms, co-morbidity and outcome data were collected for the analysis of elderly bacteremia patients upon taking blood cultures. During the study period, a total of 144 patients met the criteria, including 83 men (57.6%) and 61 women (42.4%). The mean age was 80±7.9 years (range, 65-99 years). Clinical features included sepsis in 4 patients (2.8%), severe sepsis in 30 patients (20.8%), and septic shock in 54 patients (37.5%). Twenty-two (15.3%) patients presented with fever, and 46 (31.9%) with hypothermia. The mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 23.8±9.7 (range, 6-54). The most frequently encountered comorbidities were ventilator requirement (91%), followed by acute renal failure (51.4%), and gastrointestinal bleeding (32.6%). A total of 207 microorganism isolates were identified. Aerobic gram-negative microorganisms accounted for 128 (61.8%) isolates. The most commonly isolated microorganisms were oxacillin-resistant Staphylococcus aureus (17.4%), followed by Klebsiella pneumoniae (16.4%), Escherichia coli (14%), Streptococcus species (10.6%), and Pseudomonas aeroginosa (7.7%). Forty-four patients (30.6%) received inadequate antibiotic treatment. The overall in-ICU mortality rate was 54.2%. The significant independent risk factors for mortality were hypothermia (p＜0.05), increasing APACHE II score (p＜0.01), septic shock (p＜0.001), bandemia (p＜0.05), thrombocytopenia (p＜0.05), metabolic acidosis (p＜0.001), hypoalbuminemia (p＜0.01), inadequate antibiotic treatment (p＜0.01), ventilator requirement (p＜0.001) and acute renal failure (p=0.001). The results of this study demonstrate the clinical characteristics and highlight the independent prognostic factors for elderly patients with bacteremia in the ICU.

並列關鍵字

bacteremia ； elderly patients ； intensive care unit