Table 1 Epidemiologic characteristics in the elderly patients with sepsis Table 2 Main underlying disease

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1 Key words: elderly patient, sepsis, multiple organ failure (MOF)

2 Table 1 Epidemiologic characteristics in the elderly patients with sepsis Table 2 Main underlying disease

3 Fig. 1 The yearly frequency patterns of organisms from blood culture in the elderly : S.aureus is identified to MRSA or MSSA from October Table 3 Organisms isolated from blood culture in the elderly MRSA: Methicillin-resistant Staphylococcus aureus MSSA: Methicillin-sensitive Staphylococcus aureus CNS: Coagulase-negative staphylococci GPR: Gram-positive rods GNR: Gram-negative rods Table 4 Site of infection

4 Fig. 2 The frequency patterns of organisms from blood culture in the elderly : S.aureus is identified to MRSA and MSSA from October 1989.

5 Table 5 Clinical features with sepsis in the elderly Table 6 Results of coagulation test with DIC due to sepsis in the elderly Number of DIC patients=28 MOF: Multiple organ failure DIC: Disseminated intravascular coagulation FDP: Fibrin/fibrinogen degradation products AT III: Antithrombin III TAT: Thrombin-antithrombin III complex PIC: Plasmin-ƒ 2 plasmin inhibitor complex

6 Table 7 Baseline characteristics with sepsis between survivors and nonsurvivors in the elderly

7 Fig. 3 Comparison of organisms from blood culture in the elderly between survivors and nonsurvivors : S.aureus is identified to MRSA and MSSA from October 1989.

8

9 6) MaGowan, J. E. Jr., Barnes, M. W. & Finland, M.: Bacteremia at Boston city hospital: Occurrence and mortality during 12 selected ears ( ), with special reference to hospital acqurired cases. J. Infect. Dis., 123: ) Eykyn, S. J.: Infection and intravenous catheters. J. Antimicrob. Chemother., 14: , ) Pettigrew, R. A., Lang, S. D. R., Haydock, D. A. & Hill, G. L.: Catheter-related sepsis in patients on intravenous nutrition: A prospective study of quantitative catheter cultures and guidewire changes for suspected sepsis. Br. J. Surg., 72: 52

10 16) Mcclure, C. L.: Common infection in the elderly. Am. Fam. Physician., 45: , B. E., Ortolani, C., Cozzi, E., Monti, D., Frances- 21) Fagiolo, U., Cossarizza, A., Scala, E., Fanales, 17) Rolando, N., Harvey, F. & Brahm, J.: Prochi, C. & Paganelli, R.: Increased cytokine spective study of bacterial infection in acute production in mononuclear cells of healthy liver failure: An analysis of fifty patients. elderly people. Eur. J. Immunol., 23: Hepatology, 11: 49-53, , ) Bender, B. S.: Sepsis. Clin. Geriatr. Med., 8: , Study on Sepsis in the Elderly at Nagoyashi-Koseiin Geriatric Hospital Toshinobu YAMAMOTO, Kanzo SUZUKI, Masahiro YAMAKOSHI & Toshiyuki YAMAMOTO Department of Internal Medicine, Nagoyashi-Koseiin Geriatric Hospital A study based on clinical analysis was conducted regarding the 125 episodes in the elderly 112 patients of sepsis who were 70 (average 83.8 } 7.5) years old at Nagoyashi-Koseiin Geriatric Hospital from 1985 through ) The backgrounds of the elderly patients with sepsis were as follows: bedridden (72.8%), urinary catheter in place (61.2%), central venous catheter in place (48.8%), and prior antibiotic use (40.8%). All patients had an underlying disease. 2) Organisms isolated were Escherichia coli (21.2%), Staphylococcus aureus (18.4%), Coagulase-negative staphylococci (CNS) (17.4%) and Candida albicans (6.1%). Chrologically, the quantity of gram-positive cocci increased while that of gram-negative bacilli decreased. As the age of the patients increased, the frequency of infections by Methicillin-resistant Staphylococcus aureus (MRSA), E. coli, and/or multiple bacteria increased, while that of infections by CNS and gram-negative bacilli excluding E. coli decreased. 3) The primary infected sites were the urinary tract system (24.8%), central venous catheter (21.6%) and unknown (31.2%). 4) The primary clinical observations were fever exceeding 38.0 Ž (88.0%), tachycardia (60.8%), shivering (44.0%) and cyanosis (32.8%). 5) Complications were multiple organ failure (33.6%), septic shock (26.4%) and disseminated intravascular coagulation (22.4%). 6) The prognosis indicated that 65.6% were survivors, and 34.4% were nonsurvivors. At the onset of sepsis, weight, blood pressure, serum albumin, and total cholesterol in the nonsurvivors were significantly lower than those in the survivors, whereas heart rate, GOT, LDH, and BUN in the nonsurvivors were significantly higher than those in the survivors.

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