El objetivo de este estudio ha sido determinar los factores asociados, en relación con la evolución mortal, de las bacteriemias-fungemias ocurridas en un año, y comparar los resultados en la población con edades comprendidas entre 60 y 70 años y la población mayor de 70 años. Estudio descriptivo, prospectivo de todos los episodios de bacteriemias-fungemias producidos en el Hospital Universitario de la Princesa de Madrid, entre el 16 de mayo de1996 y el 14 de mayo de1997. Se utilizaron las mismas definiciones en los dos grupos de estudio. El análisis univariado de los resultados se realizó con el test de la χ2 y las variables con más de dos categorías mediante regresión logística, considerándose significación estadística un valor de p < 0,05. Un total de 250 episodios han sido analizados, 158 en personas mayores de 70 años frente a 92 episodios en el grupo de pacientes con edades comprendidas entre 60 y 70 años. Globalmente, no existe diferencia en cuanto a la mortalidad en ambos grupos (odds ratio [OR] = 1,22; intervalo, 0,66-2,24). El servicio que más episodios recibe en ambos grupos es el médico. Los microorganismos más frecuentes asociados a bacteriemia son los gramnegativos. La adquisición extrahospitalaria es la más habitual. El origen más frecuente es el vascular en el grupo de 60-70 años, y el genitourinario en el grupo de los mayores de 70 años. Hay un alto porcentaje de tratamientos quirúrgicos adecuados en ambos grupos. Las variables con significación clínica y estadística en cuanto a la evolución mortal en el grupo de 60-70 años son: adquisición intrahospitalaria (OR = 6,28 [1,9-20,7]); hipotensión(OR = 4,46 [1,14-17,4]); coagulacion intravascular diseminada (OR = 4,93 [3,14-7,75]). Sin embargo, se asocia a menor evolucion mortal la realizacion de un tratamiento quirurgico adecuado (OR = 10,76 [2,017-57,05]). En el grupo de mas de 70 anos son factores asociados a mal pronostico en cuanto a evolucion a muerte: uso previo de antibioticos (OR = 2,71 [1,25-6,13]); hipotension (OR = 3,35 [1,34-8,36]); trombopenia (OR = 2,7 [0,97-7,69]); coagulación intravascular diseminada (OR = 7,51 [0,65-83]). Sin embargo, también el tratamiento quirúrgico adecuado es un factor asociado a mejor pronóstico (OR = 6,03 [1,62-22,35]). No existen diferencias en cuanto a mortalidad en las personas con edades comprendidas entre 60 y 70 años y en los mayores de 70 años. Muchas de las variables se mantienen constantes en ambos grupos, lo que indica la potencia de dichas variables independientemente de la edad, siendo llamativa la asociación a mejor pronóstico del tratamiento quirúrgico adecuado, lo que debe favorecer dicho tipo de intervención terapéutica en caso necesario, independientemente de la edad. The aim of this study was to analyze the factors associated with death from bacteraemias and fungemias over a 1-year period and to compare the results in individuals aged 60-70 years old with those in individuals aged more than 70 years. We performed a prospective, descriptive study of all episodes of bacteraemias-fungemias in the Princesa de Madrid University Hospital between 16/5/1996 and 14/5/1997. The same definitions were used in both study groups. Univariate analysis was performed with the Chi-square test and variables with more than two categories were analyzed using logistic regression. Values of p < 0.05 were considered statistically significant. A total of 250 episodes were analyzed. There were 158 episodes in individuals aged more than 70 years and 92 episodes in the group of patients aged 60-70 years. Overall, there was no difference in mortality between the two groups: OR 1.22 (0.66-2.24). The department with the greatest number of episodes of bacteraemia in both groups was the medical department. The microorganisms most frequently associated with bacteraemia were Gram-negative. Extrahospital acquisition was more frequent than intrahospital acquisition. The most frequent origins were vascular procedures in the group aged 60-70 years and genitourinary procedures in the group aged more than 70 years. Appropriate surgi- cal treatment was frequent in both groups. The clinically and statistically significant variables associated with mortality in the group aged 60-70 years were: intrahospital acquisition [OR 6.28 (1.9-20.7)], hypotension [OR 4.46 (1.14-17.4)], and disseminated intravascular coagulation [OR 4.93 (3.14-7.75)]. However, lower mortality was associated with appropriate surgical treatment [OR 10.76 (2.017-57.05)]. In the group aged more than 70 years, the factors associated with mortality were: prior use of antibiotics [OR 2.71 (1.25-6.13)], hypotension [OR 3.35 (1.34- 8.36)], thrombopenia [OR 2.7 (0.97-7.69)], and disseminated intravascular coagulation [OR 7.51 (0.65-83)]. However, appropriate surgical treatment was also associated with improved prognosis in this group [OR 6.03 (1.62-22.35)]. No differences were found in mortality between patients aged 60-70 years and those aged more than 70 years. Many of the variables were similar in both groups. Notable was the association between improved prognosis and appropriate surgical treatment, which should encourage the use of this type of intervention, when required, independent of age.

OBJECTIVE:Eighty-two episodes of polymicrobial bacteremia in two time periods, 1986-87 and 1996-97, were compared to assess differences in risk factors and outcome to mortality.METHODS:A prospective, concurrent, anterograde study with univariate analysis of all episodes of polymicrobial bacteremia was performed in Hospital de la Princesa. Logistic regression analysis was applied to all significant variables (p < 0.05) in the univariate analysis in either of the two time periods.RESULTS:Variables showing statistically significant differences in incidence between the two time periods included the following: hospital acquired bacteremia; previous use of antibiotics; genitourinary, respiratory and cardiovascular manipulations; septic metastases; and absence of leukocytosis. These factors were more frequently present during 1986-87 than during 1996-97. The overall RR of outcome to mortality was five-fold greater during the first period than the second: RR 5.6 (CI 1.76-17.56) p < 0.001. The clinical characteristics at the onset of bacteremia associated with mortality in the first period were: underlying disease - < RR 2.20 (CI 1.18-4.08), steroid treatment - < RR 4.24 (CI 0.68-26.59), hypotension - < RR 2.05 (CI 1.0-4.17), and disseminated intravascular coagulation - < RR 2.31 (CI 1.69-3.35). Clinical characteristics at the onset of bacteremia associated with mortality in the second period were: hypotension - < RR 1.44 (CI 1.01-2.08), underlying disease - < RR 1.16 (CI 1.02-1.34), and disseminated intravascular coagulation - < RR 6.40 (CI 1.15-35.69). The variables independently associated with mortality in polymicrobial bacteremia were: period - < RR 2.05 (CI 1.50-2.10), underlying disease - < RR 7.05 (CI 2.68-7.50), hypotension - < RR 7.06 (CI 3.80-7.29), and (probably) vascular manipulations - < RR 3.41 (CI 0.85-4.53).CONCLUSION:Polymicrobial bacteremia-associated mortality was five-fold greater in 1986-87 than in 1996-97. The variables independently associated with mortality risk were underlying disease, hypotension, the period studied (which would include a number of variables not analyzed in this work) and, probably, vascular manipulations.

OBJECTIVE. Eighty-two episodes of polymicrobial bacteremia in two time periods, 1986-87 and 1996-97, were compared to assess differences in risk factors and outcome to mortality. METHODS. A prospective, concurrent, anterograde study with univariate analysis of all episodes of polymicrobial bacteremia was performed in Hospital de la Princesa. Logistic regression analysis was applied to all significant variables (p < 0.05) in the univariate analysis in either of the two time periods. RESULTS. Variables showing statistically significant differences in incidence between the two time periods included the following: hospital acquired bacteremia; previous use of antibiotics; genitourinary, respiratory and cardiovascular manipulations; septic metastases; and absence of leukocytosis. These factors were more frequently present during 1986-87 than during 1996-97. The overall RR of outcome to mortality was five-fold greater during the first period than the second: RR 5.6 (Cl 1.76-17.56) p < 0.001. The clinical characteristics at the onset of bacteremia associated with mortality in the first period were: underlying disease - < RR 2.20 (Cl 1.18-4.08), steroid treatment - < RR 4.24 (Cl 0.68-26.59), hypotension - < RR 2.05 (Cl 1.0-4.17), and disseminated intravascular coagulation - < RR 2.31 (Cl 1.69-3.35). Clinical characteristics at the onset of bacteremia associated with mortality in the second period were: hypotension - < RR 1.44 (Cl 1.01-2.08), underlying disease - < RR 1.16 (Cl 1.02-1.34), and disseminated intravascular coagulation - < RR 6.40 (Cl 1.15-35.69). The variables independently associated with mortality in polymicrobial bacteremia were: period - < RR 2.05 (Cl 1.50-2.10), underlying disease - < RR 7.05 (Cl 2.68-7.50), hypotension - < RR 7.06 (Cl 3.80-7.29), and (probably) vascular manipulations - < RR 3.41 (Cl 0.85-4.53). CONCLUSION. Polymicrobial bacteremia-associated mortality was five-fold greater in 1986-87 than in 1996-97. The variables independently associated with mortality risk were underlying disease, hypotension, the period studied (which would include a number of variables not analyzed in this work) and, probably, vascular manipulations.

Se han estudiado 82 episodios de bacteriemias-fungemias polimicrobianas (BFP) en dos diferentes períodos (1986-1987 y 1996-1997) para valorar las diferencias en los factores pronósticos con evolución a muerte. Estudio prospectivo, concurrente y anterógrado con análisis univariado de todos los episodios de BFP en el Hospital de La Princesa. Posteriormente se realizó regresión logística de todas las variables que presentaron significación estadística en el análisis univariado en al menos alguno de los dos períodos. Las variables con diferencias en la incidencia entre los períodos de estudio estadísticamente significativas fueron adquisición intrahospitalaria, uso previo de antibióticos, manipulaciones genitourinarias, respiratorias y cardiovasculares, metástasis sépticas y ausencia de leucocitosis, que fueron más frecuentes durante 1986-1987 que durante 1996-1997. Globalmente el riesgo relativo (RR) de evolución a muerte fue 5 veces mayor durante el primer período que en el segundo (RR, 5,6 [IC, 1,76-17,56]) p < 0,001. Las variables que se asociaron a incremento de la mortalidad durante el primer período fueron: presencia de enfermedad de base (RR, 2,20 [IC, 1,18-4,08]), tratamiento esteroideo (RR, 4,24 [IC, 0,68-26,59]), hipotensión (RR, 2,05 [IC, 1,0-4,17]), y presencia de coagulación intravascular diseminada (CID) (RR, 2,31 [IC, 1,69-3,35]). Las variables asociadas a muerte en el segundo período fueron: hipotensión (RR, 1,44 [IC, 1,01-2,08]), la presencia de enfermedad de base (RR, 1,16 [IC, 1,02-1,34]), y la existencia de CID (RR, 6,40 [IC, 1,15-35,69]). Las variables que de forma independiente incrementan la mortalidad en las bacteriemias polimicrobianas son: período (RR, 2,05 [IC, 1,50-2,10]), presencia de enfermedad de base (RR, 7,05 [IC, 2,68-7,50]), y la existencia de hipotensión (RR, 7,06 [IC, 3,80-7,29]). En el período entre 1986-1987 la mortalidad asociada a BFP fue 5 veces mayor que entre 1996-1997. Las variables que de forma independiente se asocian a este incremento de la mortalidad son la existencia de enfermedad de base, la presencia de hipotensión y el propio período (que incluiría toda una serie de variables que no se han analizado en este trabajo). Eighty-two episodes of polymicrobial bacteremia in two time periods, (1986-87) and (1996-97), were compared to assess differences in risk factors and outcome to mortality. A prospective, concurrent, anterograde study with univariate analysis of all episodes of polymicrobial bacteremia was performed in Hospital de la Princesa. Logistic regression analysis was applied to all significant variables (p < 0.05) in the univariate analysis in either of the two time periods. Variables showing statistically significant differences in incidence between the two time periods included the following: hospital acquired bacteremia; previous use of antibiotics; genitourinary, respiratory and cardiovascular manipulations; septic metastases; and absence of leukocytosis. These factors were more frequently present during 1986-87 than during 1996-97. The overall RR of outcome to mortality was five-fold greater during the first period than the second: RR 5.6 (CI 1.76-17.56) p < 0.001. The clinical characteristics at the onset of bacteremia associated with mortality in the first period were: underlying disease - < RR 2.20 (CI 1.18-4.08), steroid treatment - < RR 4.24 (CI 0.68-26.59), hypotension - < RR 2.05 (CI 1.0-4.17), and disseminated intravascular coagulation - < RR 2.31 (CI 1.69-3.35). Clinical characteristics at the onset of bacteremia associated with mortality in the second period were: hypotension - < RR 1.44 (CI 1.01-2.08), underlying disease - < RR 1.16 (CI 1.02-1.34), and disseminated intravascular coagulation - < RR 6.40 (CI 1.15-35.69). The variables independently associated with mortality in polymicrobial bacteremia were: period - < RR 2.05 (CI 1.50-2.10), underlying disease - < RR 7.05 (CI 2.68-7.50), hypotension - < RR 7.06 (CI 3.80-7.29), and (probably) vascular manipulations - < RR 3.41 (CI 0.85-4.53). Polymicrobial bacteremia-associated mortality was five-fold greater in 1986-87 than in 1996-97. The variables independently associated with mortality risk were underlying disease, hypotension, the period studied (which would include a number of variables not analyzed in this work) and, probably, vascular manipulations.