TY - JOUR
T1 - Clinical characteristics, treatment and outcomes of MRSA bacteraemia in the elderly
AU - Cuervo, Guillermo
AU - Gasch, Oriol
AU - Shaw, Evelyn
AU - Camoez, Mariana
AU - Domínguez, María Ángeles
AU - Padilla, Belén
AU - Pintado, Vicente
AU - Almirante, Benito
AU - Lepe, José A.
AU - López-Medrano, Francisco
AU - Ruiz de Gopegui, Enrique
AU - Martínez, José A.
AU - Montejo, José Miguel
AU - Perez-Nadales, Elena
AU - Arnáiz, Ana
AU - Goenaga, Miguel Ángel
AU - Horcajada, Juan Pablo
AU - Rodríguez-Baño, Jesús
AU - Pujol, Miquel
AU - Jover, A.
AU - Barcenilla, F.
AU - Garcia, M.
AU - Domínguez, M. A.
AU - Dueñas, C.
AU - Ojeda, E.
AU - Martinez, J. A.
AU - Marco, F.
AU - Chaves, F.
AU - Lagarde, M.
AU - Bereciartua, E.
AU - Hernández, J. L.
AU - Von Wichmann, M. A.
AU - Goenaga, M. A.
AU - García-Arenzana, J. M.
AU - Padilla, C.
AU - Cercenado, E.
AU - García-Pardo, G.
AU - Tapiol, J.
AU - Montero, M.
AU - Salvado, M.
AU - Fernandez, C.
AU - Calbo, E.
AU - Xercavins, M.
AU - Granados, A.
AU - Fontanals, D.
AU - Loza, E.
AU - Torre-Cisneros, J.
AU - Rodríguez-López, F.
AU - Benito, N.
N1 - Funding Information:
B. A. has received funding for research from Pfizer, Novartis, Gilead and MSD, and funds for advisory board membership from Pfizer, Gilead, Novartis, Janssen, Astellas and MSD. N. B. has received funding for speaking, consultancy, advisory board membership and travel from MSD, Pfizer, Gilead, Novartis and AstraZeneca. J. R-B. has received funding for research from Novartis, has served as speaker for Astellas, Merck, Astra-Zeneca and Pfizer, and has been a consultant for Roche, Novartis and Janssen. All other authors: none to declare.
Funding Information:
O. G. was recipient of a Río Hortega Grant ( CM08/228 ) from the Instituto de Salud Carlos III.
Funding Information:
This study was supported by Ministerio de Ciencia e Innovación , Instituto de Salud Carlos III ( FIS 08/0335 ) and co-financed by the European Development Regional Fund ‘A way to achieve Europe’ ERDF, Spanish Network for Research in Infectious Diseases ( REIPI RD06/0008 ).
Publisher Copyright:
© 2015 The British Infection Association.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - 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.
AB - 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.
KW - Bacteraemia
KW - Elderly
KW - MRSA
UR - http://www.scopus.com/inward/record.url?scp=84958164726&partnerID=8YFLogxK
U2 - 10.1016/j.jinf.2015.12.009
DO - 10.1016/j.jinf.2015.12.009
M3 - Article
C2 - 26723914
AN - SCOPUS:84958164726
VL - 72
SP - 309
EP - 316
JO - Journal of Infection
JF - Journal of Infection
SN - 0163-4453
IS - 3
ER -