Age-related Trends in Adults with Community-onset Bacteremia [PublishAheadOfPrint]

To understand the epidemiological variation in bacteremia characteristics among differently aged populations, adults with community-onset bacteremia during a 6-year period were studied in a retrospective cohort. A total of 2,349 bacteremic patients were stratified into four age categories: young adults (18-44 years old; 196 patients, 8.3%), adults (45-64; 707, 30.1%), the elderly (65-84; 1,098, 46.7%), and the oldest old (≥ 85; 348, 14.8%). Age-related trends in critical illness (a Pitt bacteremia score ≥ 4) at bacteremia onset, antibiotic-resistant pathogens (ESBL-producing Escherichia coli, Klebsiella species, and Proteus mirabilis [EKP]; methicillin-resistant Staphylococcus aureus [MRSA]; and levofloxacin non-susceptible EKP), inappropriate empirical antibiotic therapy (EAT), and 4-week mortality rate were observed. Using a multivariate regression model, critical illness at bacteremia onset (adjusted odds ratio [AOR], 9.03; P < 0.001) and inappropriate EAT (AOR, 2.67; P < 0.001) were the two leading predictors of 4-week mortality. Moreover, ESBL-producing EKP (AOR, 12.94; P<0.001), MRSA (AOR, 8.66; P<0.001), and levofloxacin non-susceptible EKP (AOR, 4.27; P<0.001) were linked to inappropriate EAT. Conclusively, among adults with community-onset bacteremia, significant positive age-related trends were noted in antibiotic-resistant pathogens and bacteremia severity, which were related to the increasing incidence of inappropriate EAT and 4-week mortality with age. Thus, different empirical antimicrobial regimens should be considered for distinct age groups.

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