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Épidémiologie des bactériémies chez le sujet âgé

Bacteremia in the elderly population

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Les cahiers de l'année gérontologique

Résumé

Environ un tiers des bactériémies concerne des patients âgés de plus de 85 ans. Elles sont associées à des taux de mortalité et de morbidité accrus dans cette population. La présentation clinique est atypique avec une diminution des signes spécifiques d’infection et la présence de signes aspécifiques comme l’altération de l’état général ou les chutes. Les portes d’entrée les plus fréquentes sont urinaires, pulmonaires et digestives. Les bacilles Gram négatif, en particulier Escherichia coli, sont les bactéries les plus fréquemment isolées et de manière plus élevée que dans la population jeune. La gravité du sepsis est déterminante dans la prise en charge ainsi que l’initiation rapide d’un traitement antibiotique probabiliste et le traitement de la porte d’entrée infectieuse. Le taux de mortalité se situe entre 10 et 30 % selon les études. Les facteurs de risque de mortalité sont principalement les comorbidités, les statuts fonctionnel et nutritionnel, le délai de mise en route d’une antibiothérapie adaptée et le caractère nosocomial de l’infection. La porte d’entrée urinaire est un facteur protecteur.

Abstract

Around one third of the bacteremia episodes concerned elderly population (> 85 years old) with a poorer mortality and morbidity rate compared to younger patients. Atypical clinical presentation (absence of fever, presence of falls or delirium) makes diagnosis difficult. The most prevalent portals of entry are the urinary tract infection, pneumonia and digestive infections. Gram-negative bacilli (especially Escherichia coli) are more often identified than in the younger population. The bacteremia management is based on the evaluation of the severity of the sepsis, the timely initiation of an empirical antibiotic therapy and the treatment of the source of infection. Mortality rate is between 10 and 30%in the literature. Comorbidities, functional and nutritional status, inappropriate antibiotic therapy and nosocomially acquired bacteremia are the most prevalent risk factor for death, an urinal portal of entry was a protective factor.

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Authors and Affiliations

  1. Pôle de gérontologie clinique, CHU hôpitaux de Bordeaux, F-33000, Bordeaux, France

    C. Roubaud-Baudron

  2. Laboratoire de bactériologie, INSERM U853, Université de Bordeaux, F-33000, Bordeaux, France

    C. Roubaud-Baudron

  3. Université de Grenoble-Alpes (GREPI-AGIM FRE 3405 CNRS), Grenoble-Alpes, France

    G. Gavazzi

  4. Clinique universitaire de médecine gériatrique, CHU de Grenoble, F-38043, Grenoble cedex 09, France

    G. Gavazzi

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Correspondence to C. Roubaud-Baudron.

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Roubaud-Baudron, C., Gavazzi, G. Épidémiologie des bactériémies chez le sujet âgé. cah. année gerontol. 6, 102–106 (2014). https://doi.org/10.1007/s12612-014-0404-8

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