Objectives: To describe clinical features, microbiologic characteristics and outcome of bacteremia in the elderly patients hospitalized in a geriatric hospital.
Patients and methods: All episodes of bacteremia diagnosed from January 1(st) to December 31(st) 1998 were analysed, excluding false-positive cases due to skin contamination. The hospital comprises 1084 geriatric beds distributed as 111 in acute care (ACF), 333 in rehabilitation and intermediate-care (RICF), and 516 in long-term-care facilities (LTCF).
Results: Sixty-six episodes of bacteremia were observed in 65 patients. Among them 59 (89%) were nosocomial bacteremia distributed as 20 in ACF, 29 in RICF and 10 in LTCF (rates of 0.6, 0.35, and 0.05 episodes per 1000 patient-days, respectively.). Escherichia coli and Staphylococcus aureus were the main bacterial species involved in 31% and 28% of the cases, respectively. E. coli strains were 50% resistant to amoxicillin and 41% resistant to co-amoxiclav, and 68% of S. aureus strains were resistant to methicillin. Portals of entry were urinary tract (44%), respiratory tract (14%), digestive tract (11%), and soft tissue (8%). The same bacterial strain as in bacteremia was isolated from a peripheric site in 30 cases (47%), most of them being urines. For 15% cases, portal of entry cannot be determined. Mortality associated to nosocomial bacteremia was 25%, and death was significantly associated to MRSA, urinary or intravascular devices, chronic wounds and inappropriate antibiotic prescription.
Conclusion: In geriatric hospitals, bacteremia are mainly nosocomial cases. Prevention should focus on indwelling devices and antibiotic resistance.