Atypical presentation of bacteremia in older patients is a risk factor for death.

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Atypical presentation of bacteremia in older patients is a risk factor for death.

Am J Med. 2019 Jun 01;:

Authors: Hyernard C, Breining A, Duc S, Kobeh D, Dubos M, Prevel R, Cazanave C, Lambert M, Bonnet F, Mercie P, Contis A, Duffau P, Camou F, Guerville F, Rainfray M, Roubaud-Baudron C

BACKGROUND: The absence of fever in bacteremia in older patients is known to delay diagnosis. Our objective was to determine whether atypical presentation was associated to mortality due to bacteremia in older patients and factors associated with this atypical presentation.
METHODS: We conducted an observational prospective study in two French university hospitals in 2016-2017 including patients aged ≥75years with bacteremia. Atypical presentation was defined as the absence of a temperature≥38.3°C or<36°C, chills or hypotension. Mortality and dependence for Activities of Daily Living (ADL) were recorded at 1week (D7) and 3months (D90).
RESULTS: Among the 151 patients (mean age 85.4±5.8years) enrolled, atypical presentation prevalence was 21.2%. D7 and D90 mortality rates were 7.9% and 40.0%, respectively.. Atypical presentation was independently associated with D7 (odds ratio (OR) 4.46, 95% confidence interval (CI) 1.04-19.24) and D90 mortality (OR 3.76, 95% CI 1.30-10.92) after controlling for other prognostic factors. Diabetic patients and those infected with Staphylococcus aureus were more likely to have atypical signs of infection. ADL score decreased from 3.6±2.0 before bacteremia to 2.8±2.1 at D90 (p<0.001).
CONCLUSION: Older patients with bacteremia have poor vital and functional prognoses in the short and long terms. The absence of typical signs of infection is associated with mortality. Blood culture should be considered for older, especially diabetic patients with acute unexplained clinical manifestations.

PMID: 31163127 [PubMed - as supplied by publisher]

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