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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0005"></elsevierMultimedia></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introducci&#243;n y objetivos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Los pacientes de edad avanzada&#44; como consecuencia tanto del deterioro de su sistema inmunol&#243;gico por el propio proceso de envejecimiento&#44; como por las comorbilidades asociadas&#44; son proclives a sufrir un mayor n&#250;mero de procesos infecciosos<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Estas infecciones con frecuencia son de mayor gravedad&#44; tienen formas de presentaci&#243;n at&#237;pica y conllevan mayor mortalidad<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; La cantidad de personas de 80 a&#241;os o m&#225;s est&#225; en aumento en nuestra sociedad&#44; representando el 4&#44;6&#37; de la poblaci&#243;n total en la actualidad&#46; Se prev&#233;&#44; seg&#250;n los datos del Instituto Nacional de Estad&#237;stica &#40;INE&#41;&#44; que esta cifra ser&#225; del 7&#37; en los pr&#243;ximos 10 a&#241;os y del 9&#37; en el 2040&#44; representando respectivamente cifras de 3&#46;491&#46;964 y 4&#46;683&#46;211 espa&#241;oles<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Algunos estudios describen las caracter&#237;sticas de los pacientes con bacteriemia de m&#225;s de 65 a&#241;os de edad<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Sin embargo&#44; disponemos de pocos datos referentes espec&#237;ficamente a los mayores de 80 a&#241;os&#44; una poblaci&#243;n que&#44; adem&#225;s de estar aumentando de forma considerable en nuestro medio&#44; consume un mayor n&#250;mero de recursos sanitarios&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El objetivo de este trabajo es describir las caracter&#237;sticas de las bacteriemias en las personas de m&#225;s de 80 a&#241;os&#44; identificar posibles factores relacionados con la mortalidad y compararlos con otros grupos de edad&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Dise&#241;o y &#225;mbito</span><p id="par0040" class="elsevierStylePara elsevierViewall">Estudio retrospectivo de cohortes&#44; de todos los episodios de bacteriemia recogidos en el registro del Servicio de Microbiolog&#237;a del Hospital Universitario Mutua de Terrassa &#40;HUMT&#41;&#44; desde el 1 de enero de 2004 hasta el 1 de diciembre de 2007&#44; a partir de la revisi&#243;n de historias cl&#237;nicas&#46; El HUMT es un hospital docente de agudos con 26&#46;000 altas&#47;a&#241;o&#44; es referencia de un &#225;rea poblacional de aproximadamente 350&#46;000 habitantes y dispone de servicios m&#233;dicos&#44; incluyendo oncolog&#237;a y hematolog&#237;a&#44; servicios quir&#250;rgicos &#40;excepto cirug&#237;a card&#237;aca&#41; y unidad de cuidados intensivos&#46; Se realiza trasplante aut&#243;logo de progenitores hematopoy&#233;ticos&#44; pero no trasplante de &#243;rganos s&#243;lidos&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Pacientes</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se describen las caracter&#237;sticas cl&#237;nicas&#44; microbiol&#243;gicas y de mortalidad de los pacientes de 80 a&#241;os o m&#225;s en quienes se detect&#243; bacteriemia de entidad cl&#237;nica&#44; y se comparan con las observadas en los restantes pacientes con edades comprendidas entre 65 y 79 a&#241;os o entre 18 y 64 a&#241;os&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Para el diagn&#243;stico de bacteriemia se han seguido las recomendaciones de las gu&#237;as cl&#237;nicas de la Sociedad Espa&#241;ola de Enfermedades Infecciosas y Microbiolog&#237;a Cl&#237;nica &#40;SEIMC&#41; 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de forma retrospectiva&#44; por los investigadores&#46; En cada episodio de bacteriemia&#44; adem&#225;s de los datos demogr&#225;ficos generales &#40;edad y g&#233;nero&#41; y del microorganismo responsable de la bacteriemia&#44; se recogieron las siguientes variables&#58;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Comorbilidades</span><p id="par0075" class="elsevierStylePara elsevierViewall">Se registr&#243; la existencia de cardiopat&#237;a isqu&#233;mica&#44; insuficiencia card&#237;aca&#44; enfermedad vascular perif&#233;rica&#44; enfermedad cerebrovascular&#44; demencia&#44; enfermedad respiratoria cr&#243;nica &#40;enfermedad pulmonar obstructiva cr&#243;nica o asma&#41;&#44; enfermedad del tejido conectivo&#44; &#250;lcera p&#233;ptico&#44; hepatopat&#237;a leve &#40;cirrosis sin hipertensi&#243;n portal&#44; hepatitis&#41; y moderada-cr&#243;nica &#40;con hipertensi&#243;n portal documentada&#41;&#44; diabetes mellitus con y sin afectaci&#243;n de &#243;rganos diana&#44; insuficiencia renal moderada-grave&#44; cualquier tumor con y sin met&#225;stasis&#44; leucemia &#40;aguda o cr&#243;nica&#41;&#44; linfoma&#44; e infecci&#243;n por virus de inmunodeficiencia humana &#40;VIH&#41;&#46; Se calcul&#243; el &#237;ndice de Charlson para estimar el grado de comorbilidad&#46; No se registr&#243; el consumo de tabaco y alcohol&#44; pero s&#237;&#44; si el paciente era adicto a drogas por v&#237;a parenteral&#44; por la posible relaci&#243;n con la bacteriemia&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Inmunosupresi&#243;n</span><p id="par0085" class="elsevierStylePara elsevierViewall">Se consider&#243; inmunosupresi&#243;n a la presencia de&#58; <span class="elsevierStyleItalic">a&#41;</span> tratamiento corticoideo con al menos 20<span class="elsevierStyleHsp" style=""></span>mg de prednisona &#40;o equivalente&#41; durante un m&#237;nimo de 2 semanas previas al momento de la bacteriemia&#59; 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urinario&#44; vascular&#44; cat&#233;ter&#44; cut&#225;neo&#44; neurol&#243;gico&#44; osteoarticular&#44; abdominal &#40;diferenciando entre biliar y no biliar&#41;&#44; y no filiado&#46; Un foco concreto fue considerado como originario de la bacteriemia si en una muestra procedente de dicha localizaci&#243;n se demostraba la presencia del mismo microorganismo aislado en el hemocultivo&#44; o si la cl&#237;nica era clara y congruente con el microorganismo aislado&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Origen de la bacteriemia</span><p id="par0135" class="elsevierStylePara elsevierViewall">Las bacteriemias se clasificaron seg&#250;n su origen fuese comunitario&#44; nosocomial o de un medio relacionado con la atenci&#243;n sanitaria&#44; seg&#250;n las definiciones utilizadas por Friedman et al&#46; en 2002<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#44; de modo que se consideran como&#58; 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positivo<span class="elsevierStyleItalic">&#46;</span></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Evoluci&#243;n</span><p id="par0145" class="elsevierStylePara elsevierViewall">Se registr&#243; la gravedad del enfermo al ingreso&#44; registrando si hab&#237;a shock&#44; coma o necesidad de ventilaci&#243;n mec&#225;nica&#46; Tambi&#233;n se registr&#243; la situaci&#243;n vital del paciente en el momento del alta hospitalaria &#40;vivo o muerto&#41;&#46; Si hubiese fallecido&#44; se registraba si la muerte estaba relacionada con el proceso bacteri&#233;mico&#59; se consideraba como relacionado a todo fallecimiento que se diese en la primera semana posterior al hallazgo de la bacteriemia cuando los datos cl&#237;nicos as&#237; lo apoyaban&#44; y no se pod&#237;a atribuir a otra causa&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis estad&#237;stico</span><p id="par0155" class="elsevierStylePara elsevierViewall">Para la realizaci&#243;n del estudio descriptivo y del an&#225;lisis bivariante &#40;prueba de Chi-cuadrado&#41; se utiliz&#243; el programa inform&#225;tico SPSS&#44; versi&#243;n 11&#46;0&#46; En este an&#225;lisis bivariante se consider&#243; con significaci&#243;n estad&#237;stica a todo valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#46; Se utiliz&#243; STATA para el an&#225;lisis multivariado de mortalidad&#44; realizado mediante un modelo de regresi&#243;n log&#237;stica en el que la variable dependiente fue la mortalidad relacionada con la bacteriemia&#44; incluyendo como variables independientes las que obtuvieron una significaci&#243;n estad&#237;stica de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 en el an&#225;lisis bivariante&#46;</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0160" class="elsevierStylePara elsevierViewall">Entre el 1 de enero de 2004 y el 1 de diciembre de 2007&#44; se objetivaron un total de 1&#46;594 bacteriemias en adultos mayores de 18 a&#241;os &#40;5&#37; polimicrobianas&#41;&#46; Se observaron 558 episodios en el grupo entre 18 y 64 a&#241;os de edad&#44; 567 en el grupo de 65 a 79 a&#241;os y 469 en el de 80 a&#241;os o m&#225;s&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas de comorbilidad&#44; gravedad en la forma de presentaci&#243;n&#44; origen de la bacteriemia y de mortalidad global se expresan en la <a class="elsevierStyleCrossRef" href="#tbl1">tabla 1</a>&#46; El &#237;ndice de Charlson en los pacientes m&#225;s j&#243;venes &#40;18-64 a&#241;os&#41; fue de 1&#44;02&#44; en el grupo de 65-79 de 1&#44;94 y en el de los de m&#225;s de 79 a&#241;os de 1&#44;86 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><elsevierMultimedia ident="tbl1"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">En cuanto a los focos de bacteriemia&#44; el urinario fue el m&#225;s frecuente en cada grupo de edad&#44; representando el 28&#44; 44 y 44&#37; respectivamente &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<span class="elsevierStyleItalic">&#41;</span>&#44; seguido del respiratorio &#40;19&#37;&#41; en el grupo m&#225;s joven&#46; En los otros 2 grupos&#44; el segundo foco en frecuencia fue el biliar &#40;11 y 17&#37; respectivamente&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl1">tabla 1</a>&#41;&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Los microorganismos aislados se resumen en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; <span class="elsevierStyleItalic">E&#46; coli</span> fue el germen m&#225;s frecuentemente aislado en todos los grupos&#44; y especialmente en los mayores de 79 a&#241;os&#44; donde constituy&#243; el 51&#37; de los aislamientos&#44; frente al 32&#37; en los menores de 65 a&#241;os &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y al 44&#37; en los de edades comprendidas entre 65 y 59 a&#241;os &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;039&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall">La mortalidad al alta en los mayores de 80 a&#241;os fue del 21&#44;5&#37;&#44; versus el 16&#44;7&#37; en el grupo de edades comprendidas entre 65 y 79 a&#241;os &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; y el 9&#37; en los de edades comprendidas entre 18 y 64 a&#241;os &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;012&#41;&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">El an&#225;lisis crudo de relaci&#243;n observada entre la mortalidad y las caracter&#237;sticas epidemiol&#243;gicas generales&#44; las comorbilidades&#44; la gravedad cl&#237;nica&#44; los focos de sepsis&#44; la procedencia de la infecci&#243;n y los microorganismos aislados se resume en la <a class="elsevierStyleCrossRef" href="#tbl2">tabla 2</a>&#46; La presencia de insuficiencia renal&#44; neoplasias hematol&#243;gicas&#44; cirrosis&#44; inmunosupresi&#243;n&#44; desnutrici&#243;n&#44; &#250;lceras por dec&#250;bito&#44; el ser portador de sonda vesical permanente&#44; la presencia de shock o de coma&#44; el haber sido sometido a ventilaci&#243;n mec&#225;nica y la adquisici&#243;n nosocomial o en relaci&#243;n con cuidados sanitarios de la infecci&#243;n se correlacionaron con incrementos en la mortalidad en la poblaci&#243;n total&#44; sin discriminaci&#243;n de edades&#46; Por el contrario&#44; la detecci&#243;n de un foco de sepsis urinario&#44; la bacteriemia por <span class="elsevierStyleItalic">E&#46; coli</span> y la adquisici&#243;n comunitaria de la infecci&#243;n conllevaron a una menor mortalidad&#46; Si se restringe este an&#225;lisis a la poblaci&#243;n de pacientes bacteri&#233;micos de m&#225;s de 79 a&#241;os de edad&#44; nos seguimos encontrando que la presencia de insuficiencia renal&#44; desnutrici&#243;n&#44; &#250;lceras por dec&#250;bito&#44; shock o coma&#44; se correlacionaron con mayores mortalidades&#44; mientras que la presencia de focos de sepsis urinario y la bacteriemia por <span class="elsevierStyleItalic">E&#46; coli</span> se asociaron a menores mortalidades&#46;</p><elsevierMultimedia ident="tbl2"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall">El an&#225;lisis multivariado de mortalidad se resume en la <a class="elsevierStyleCrossRef" href="#tbl3">tabla 3</a>&#46; En la poblaci&#243;n total de 1&#46;594 bacteriemias las edades superiores a 65 a&#241;os&#44; la presencia de insuficiencia renal&#44; neoplasias hematol&#243;gicas&#44; cirrosis hep&#225;tica&#44; desnutrici&#243;n&#44; &#250;lceras por dec&#250;bito&#44; neutropenia&#44; sonda vesical permanente&#44; focos de sepsis respiratorio&#44; vascular o no identificable se correlacion&#243; con mayores mortalidades&#46; Sin embargo&#44; la presencia de foco de sepsis urinario o la bacteriemia por <span class="elsevierStyleItalic">E&#46; coli</span> se acompa&#241;&#243; de menores mortalidades&#46; Restringido el an&#225;lisis a los mayores de 80 a&#241;os se detect&#243; que mientras que la presencia de insuficiencia renal&#44; desnutrici&#243;n&#44; &#250;lceras por dec&#250;bito o shock se acompa&#241;aban de mayor mortalidad&#44; la presencia de focos de sepsis urinario o biliar se correlacionaban con menor mortalidad&#46;</p><elsevierMultimedia ident="tbl3"></elsevierMultimedia></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n y conclusiones</span><p id="par0195" class="elsevierStylePara elsevierViewall">Las personas presentan comorbilidades con una frecuencia que se incrementa con la edad&#44; siendo muy frecuente a partir de los 80 a&#241;os&#46; Por otra parte&#44; se sabe que el foco de bacteriemia m&#225;s frecuente en todas las edades es el urinario&#44; seguido del biliar&#44; y que no implican una mayor mortalidad que otros focos de bacteriemia&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">En la serie presentada&#44; la comorbilidad&#44; no aumenta a medida que avanzamos en los grupos de edad&#46; Mientras que&#44; como era de esperar&#44; los adultos j&#243;venes son los que tienen menos comorbilidad&#44; la presencia de neoplasias s&#243;lidas&#44; cirrosis&#44; inmunosupresi&#243;n y neutropenia&#44; se observ&#243; con mayor frecuencia en el grupo de edad comprendida entre 65 y 79 a&#241;os&#44; siendo algo menor en el grupo de edad superior a los 80 a&#241;os&#46; Los procesos anteriormente descritos implican por s&#237; mismos a una mayor mortalidad&#46; En este sentido&#44; el grupo de octogenarios ser&#237;a un grupo seleccionado&#44; por la propia naturaleza&#44; y esto explicar&#237;a una menor comorbilidad&#46; Resultados similares fueron presentados por Payeras et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">A pesar de que como en el resto de grupos&#44; el mayor porcentaje de bacteriemias en los pacientes de edad superior a los 80 a&#241;os proced&#237;a de la comunidad&#44; cabe destacar una mayor proporci&#243;n de bacteriemias procedentes de un medio relacionado con la asistencia sanitaria respecto a las de origen nosocomial&#46; Sin embargo&#44; entre los pacientes de edad comprendida entre los 65 y 79 a&#241;os las bacteriemias de origen nosocomial eran m&#225;s frecuentes que las relacionadas con la atenci&#243;n sanitaria&#46; Esto podr&#237;a ser debido en parte a que entre los mayores de 80 a&#241;os&#44; hay una proporci&#243;n mayor de enfermos institucionalizados que en el resto de grupos&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">El foco de bacteriemia m&#225;s frecuentemente observado en nuestra serie ha sido el urinario&#44; hecho congruente con lo descrito en la literatura<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;7&#44;8</span></a>&#46; La frecuencia de este foco se incrementa a medida que aumenta la edad&#46; Mientras que en los m&#225;s j&#243;venes de 65 a&#241;os el segundo foco de bacteriemia m&#225;s frecuentemente observado fue el respiratorio&#44; en los pacientes de m&#225;s de 65 a&#241;os lo fue el biliar&#44; que muestra una tendencia a aumentar en frecuencia relativa seg&#250;n se incrementa la edad&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">El microorganismo m&#225;s frecuente en los pacientes de m&#225;s de 80 a&#241;os fue <span class="elsevierStyleItalic">E&#46; coli</span>&#44; representando pr&#225;cticamente la mitad de todos los microorganismos causantes&#46; Esta circunstancia tiene importancia en relaci&#243;n al tratamiento emp&#237;rico&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Las variables que se asociaron a una mayor mortalidad en este grupo de edad fueron de entre todas las comorbilidades&#44; la insuficiencia renal&#46; La desnutrici&#243;n y la existencia de &#250;lceras fueron utilizados como estimadores indirectos del estado basal del paciente&#44; y tambi&#233;n se asociaron a una mayor mortalidad&#44; apoyando la hip&#243;tesis&#44; sugerida por otros autores de que el estado basal del hu&#233;sped determina en gran manera el pron&#243;stico de los pacientes con bacteriemia<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;9&#44;10</span></a>&#46; Es de destacar&#44; que las bacteriemias de origen urinario se muestran como &#171;factor protector&#187; en el an&#225;lisis multivariado&#44; cuando se comparan con otros focos de bacteriemia&#46; Pensamos que esto podr&#237;a explicarse por varias razones&#46; En primer lugar&#44; la mortalidad del proceso en s&#237; es baja&#59; en segundo lugar&#44; el tratamiento emp&#237;rico est&#225;ndar utilizado result&#243; adecuado en la mayor&#237;a de los casos&#44; ya que en nuestro centro de trabajo hay pocos microorganismos resistentes&#44; estando la incidencia de <span class="elsevierStyleItalic">E&#46; coli BLEE</span> durante el per&#237;odo de estudio comprendida entre el 2&#44;5 y el 3&#37;&#41; y&#44; por ende&#44; la instauraci&#243;n de la antibioterapia emp&#237;rica es m&#225;s precoz&#46; Consideraciones similares son aplicables a los pacientes con bacteriemia con foco biliar&#44; que tambi&#233;n se mostr&#243; como &#171;protector&#187; con respecto a otros or&#237;genes de bacteriemia en el grupo de mayor edad&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Debido al aumento de la esperanza de vida en nuestro medio&#44; los pacientes de edades superiores a los 80 a&#241;os constituyen una poblaci&#243;n que aumenta de forma progresiva&#46; El hecho de conocer las caracter&#237;sticas cl&#237;nicas de esta poblaci&#243;n y su pron&#243;stico debiera ayudar a los cl&#237;nicos a tomar las decisiones m&#225;s adecuadas y ajustadas a las circunstancias de cada paciente concreto y a instaurar actitudes terap&#233;uticas m&#225;s correctas en la pr&#225;ctica cl&#237;nica cotidiana&#46; Numerosos estudios han demostrado que hay diferencias muy evidentes tanto en sus caracter&#237;sticas cl&#237;nicas como en las microbiol&#243;gicas entre los pacientes con bacteriemia de edad inferior o superior a los 65 a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Diversos estudios han analizado esta poblaci&#243;n&#44; hallando diferencias entre los distintos grupos y subgrupos<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;8&#44;11</span></a>&#46; Cabe decir&#44; sin embargo&#44; que no hay una uniformidad entre ellos&#44; ni en cuanto a la edad a partir de la cual se considera &#171;anciano de edad extrema&#187;&#44; ni en cuanto a los grupos con los que se realiza el an&#225;lisis comparativo&#46; Necesitamos de m&#225;s estudios que analicen las caracter&#237;sticas cl&#237;nicas y microbiol&#243;gicas de los pacientes bacteri&#233;micos de edades m&#225;s avanzadas&#44; superiores a los 80 a&#241;os&#44; grupo de edad cada vez m&#225;s frecuente en nuestra pr&#225;ctica asistencial cotidiana y que bien podr&#237;an tener caracter&#237;sticas diferenciales&#44; espec&#237;ficas de estas edades m&#225;s avanzadas&#44; de trascendencia cl&#237;nica&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Como limitaciones de nuestro estudio&#44; hay algunos datos que no se registraron y que podr&#237;an afectar a algunos resultados&#46; Entre esta debemos mencionar como de especial relevancia el desconocimiento de los casos con &#243;rdenes de no reanimaci&#243;n o de limitaci&#243;n al esfuerzo terap&#233;utico&#44; la valoraci&#243;n del estado basal del enfermo mediante escalas objetivas en el informe de alta como el &#237;ndice de Barthel o el &#237;ndice de Katz&#44; el momento preciso del inicio y de la duraci&#243;n de la antibioterapia&#44; factores todos ellos que podr&#237;an haber jugado un papel en la evoluci&#243;n&#46; Tampoco se recogieron datos sobre el consumo de tabaco o alcohol&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; las bacteriemias incidentes en pacientes de m&#225;s de 79 a&#241;os de edad representan un porcentaje importante del total de bacteriemias en el adulto&#46; Seg&#250;n nuestro estudio&#44; los focos m&#225;s frecuentes son el urinario y el biliar&#44; y suelen ser causadas por <span class="elsevierStyleItalic">E&#46; coli</span>&#44; lo que permitir&#237;a establecer una terapia emp&#237;rica dirigida desde el primer momento&#46; La mortalidad en este grupo no parece venir condicionada por la edad&#44; sino por la presencia de comorbilidades&#44; por la gravedad en la forma de presentaci&#243;n inicial y por el estado basal de cada paciente&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0240" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El objetivo de nuestro estudio fue describir las caracter&#237;sticas de las bacteriemias detectadas en pacientes de m&#225;s de 79 a&#241;os&#44; e identificar posibles factores relacionados con la mortalidad&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes&#44; retrospectivo&#44; en el que se incluye a todos los pacientes de m&#225;s de 17 a&#241;os de edad con bacteriemia detectada entre los a&#241;os 2004-2007&#46; Se recogieron variables demogr&#225;ficas&#44; comorbilidades&#44; foco de la bacteriemia&#44; agente causante&#44; gravedad y mortalidad intrahospitalaria&#46; Los pacientes fueron clasificados en 3 franjas de edad&#58; de 18 a 64 a&#241;os &#40;G1&#41;&#44; de 65 a 79 &#40;G2&#41; y &#8805;<span class="elsevierStyleHsp" style=""></span>80 a&#241;os &#40;G3&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se analizaron 1&#46;594 episodios de bacteriemia &#40;35&#37; en G1&#44; 35&#37; en G2 y 29&#37; en G3&#41;&#46; En el G3&#44; el 47&#37; present&#243; insuficiencia renal&#44; el 83&#37; neoplasia s&#243;lida&#44; el 2&#37; inmunosupresi&#243;n&#44; el 5&#37; desnutrici&#243;n y el 38&#37; &#250;lceras por dec&#250;bito&#46; Estas proporciones fueron del 27&#44; 30&#44; 5&#44; y 2&#37;&#44; respectivamente en G2&#44; y del 15&#44; 16&#44; 12 y 5&#37;&#44; en G1 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; El foco urinario represent&#243; el 28&#44; 43 y 44&#37; en G1&#44; G2 y G3&#44; respectivamente &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01<span class="elsevierStyleItalic">&#41;</span> y el biliar&#44; 6&#44; 11 y 16&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01<span class="elsevierStyleItalic">&#41;</span>&#46; <span class="elsevierStyleItalic">E&#46; coli</span> represent&#243; el 32&#37; en G1&#44; el 44&#37; en G2 y el 51&#37; en G3&#46; La mortalidad en cada grupo de edad fue del 9&#44; 16 y 21&#37;&#46; En el an&#225;lisis multivariado&#44; la mortalidad en los &#8805;<span class="elsevierStyleHsp" style=""></span>80 a&#241;os se relacion&#243; con la insuficiencia renal&#44; la desnutrici&#243;n&#44; la presencia de &#250;lceras y el shock&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las bacteriemias en el anciano son sobretodo de origen urinario&#46; La mortalidad en estos casos depende sobre todo del estado basal del paciente y no tanto de su edad&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The aim of our study was to describe the characteristics of bacteremia detected in patients over 79 years and to identify possible factors associated with the mortality&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A retrospective cohort study&#44; which included all patients over 17 years of age with bacteremia detected between 2004-7 was performed&#46; Demographic variables&#44; comorbidities&#44; source of bacteremia&#44; causing microorganism&#44; severity and hospital mortality were recorded&#46; Patients were classified into three age groups&#58; 18 to 64 years &#40;G1&#41;&#44; 65 to 79 &#40;G2&#41; and &#8805;80 years &#40;G3&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We analyzed 1594 episodes of bacteremia &#40;35&#37; in G1&#44; 35&#37; in G2 and 29&#37; in G3&#41;&#46; In G3&#44; 47&#37; had renal failure&#44; 83&#37; solid neoplasm&#44; 2&#37; immunosuppression 5&#37; malnutrition and 38&#37; decubitus ulcers&#46; These proportions were 27&#44; 30&#44; 5 and 2&#37;&#44; respectively in G2&#44; and 15&#44; 16&#44; 12 and 5&#37; in G1 &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41;&#46; The urinary focus accounted for 28&#37;&#44; 43&#37; and 44&#37; in G1&#44; G2 and G3&#44; respectively &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41; and biliary focus 6&#44; 11 and 16&#37; &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41;&#44; in each group&#46; <span class="elsevierStyleItalic">E&#46; coli</span> accounted for 32&#37; in G1&#44; 44&#37; in G2 and 51&#37; in G3&#46; Mortality in each age group was 9&#44; 16 and 21&#37;&#46; In multivariate analysis&#44; mortality in the &#8805;80 years was associated with renal failure&#44; malnutrition&#44; the presence of ulcers and shock&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Bacteremia in the elderly are mainly of urinary origin&#46; Mortality in these cases depends primarily on the patient&#39;s baseline status rather than their age&#46;</p>"
      ]
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n seg&#250;n el grupo de edad de los microorganismos aislados&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Significaci&#243;n estad&#237;stica p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">IC del 95&#37;&#58; intervalo de confianza al 95&#37;&#59; OR&#58; <span class="elsevierStyleItalic">odds ratio</span>&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Cohorte total1&#46;594 pacientes</td><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Mayores de 79 a&#241;os469 pacientes</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">OR &#40;IC del 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">OR &#40;IC del 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>65 a 79 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&#44;08 &#40;2&#44;01-4&#44;72&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#8212;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#8212;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805; 80 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&#44;94 &#40;3&#44;18-7&#44;68&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8212;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8212;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidades</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insuficiencia renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&#44;34 &#40;1&#44;69-3&#44;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&#44;6 &#40;1&#44;8-8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neoplasia hematol&#243;gica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&#44;66 &#40;1&#44;43-4&#44;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8212;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8212;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cirrosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;5 &#40;1&#44;96-6&#44;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8212;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8212;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estado basal</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Desnutrici&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neutropenia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8212;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Shock&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No identificado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vascular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Mayores de 80 a&#241;os<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>469</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Vivos</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Fallecidos</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Fallecidos</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Muertos</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N&#46;&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">N&#46;&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N&#46;&#176;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N&#46;&#176;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;348&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">246&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="11" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidades</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insuficiencia renal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neoplasia s&#243;lida&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neoplasia hematol&#243;gica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enf&#46; resp&#46; cr&#243;nica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hepatopat&#237;a cr&#243;nica con HTP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">156&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#8805;<span class="elsevierStyleHsp" style=""></span>80 a&#241;os</td><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">N&#250;mero&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">N&#250;mero&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">N&#250;mero&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">18-64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">65-79&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insuficiencia renal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neoplasia hematol&#243;gica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enf&#46; resp&#46; cr&#243;nica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hepatopat&#237;a con HTP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inmunosupresi&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neutropenia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Desnutrici&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#218;lceras&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Portadores sonda vesical&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Situaci&#243;n cl&#237;nica inicial</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Coma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="9" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Origen &#40;adquisici&#243;n&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nosocomial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Comunitario&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Relaci&#243;n medio sanitario&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="9" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="9" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Focos de bacteriemia</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urinario&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Respiratorio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Biliar&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Abdominal &#40;no biliar&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No filiada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#40;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cat&#233;ter&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#40;15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis multivariado de mortalidad&#46; Cohorte general de 1&#46;594 pacientes &#40;2 columnas de la izquierda&#41; y cohorte de mayores de 79 a&#241;os de 469 pacientes &#40;2 columnas de la derecha&#41;</p>"
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Vol. 212. Núm. 6.
Páginas 273-280 (junio 2012)
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Visitas
2011
Vol. 212. Núm. 6.
Páginas 273-280 (junio 2012)
Original
Bacteriemias en la población de mayores de 80 años
Bloodstream infection in the up to 80 year-old-patients
Visitas
2011
G. Muñoz-Gamitoa,
Autor para correspondencia
gmunoz@mutuaterrassa.es

Autor para correspondencia.
, E. Calbo-Sebastiána, M. Riera-Garcíab, M. Xercavins-Vallsc, M. Rodríguez-Carballeiraa, J. Garau-Alemanya
a Servicio de Medicina Interna, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, España
b Unidad de Control de Infección, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, España
c Servicio de Microbiología Clínica, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, España
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Tablas (3)
Tabla 1. Características generales de la población estudiada, distribución según los grupos de edad en cuanto a comorbilidades, gravedad en la forma de presentación, origen, foco de sepsis y mortalidad
Tabla 2. Análisis univariado de la mortalidad en la población total (5 columnas de la izquierda) y en la población de más de 79 años de edad (5 columnas de la derecha)
Tabla 3. Análisis multivariado de mortalidad. Cohorte general de 1.594 pacientes (2 columnas de la izquierda) y cohorte de mayores de 79 años de 469 pacientes (2 columnas de la derecha)
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Resumen
Introducción

El objetivo de nuestro estudio fue describir las características de las bacteriemias detectadas en pacientes de más de 79 años, e identificar posibles factores relacionados con la mortalidad.

Material y métodos

Estudio de cohortes, retrospectivo, en el que se incluye a todos los pacientes de más de 17 años de edad con bacteriemia detectada entre los años 2004-2007. Se recogieron variables demográficas, comorbilidades, foco de la bacteriemia, agente causante, gravedad y mortalidad intrahospitalaria. Los pacientes fueron clasificados en 3 franjas de edad: de 18 a 64 años (G1), de 65 a 79 (G2) y ≥80 años (G3).

Resultados

Se analizaron 1.594 episodios de bacteriemia (35% en G1, 35% en G2 y 29% en G3). En el G3, el 47% presentó insuficiencia renal, el 83% neoplasia sólida, el 2% inmunosupresión, el 5% desnutrición y el 38% úlceras por decúbito. Estas proporciones fueron del 27, 30, 5, y 2%, respectivamente en G2, y del 15, 16, 12 y 5%, en G1 (p<0,01). El foco urinario representó el 28, 43 y 44% en G1, G2 y G3, respectivamente (p<0,01) y el biliar, 6, 11 y 16% (p<0,01). E. coli representó el 32% en G1, el 44% en G2 y el 51% en G3. La mortalidad en cada grupo de edad fue del 9, 16 y 21%. En el análisis multivariado, la mortalidad en los ≥80 años se relacionó con la insuficiencia renal, la desnutrición, la presencia de úlceras y el shock.

Conclusiones

Las bacteriemias en el anciano son sobretodo de origen urinario. La mortalidad en estos casos depende sobre todo del estado basal del paciente y no tanto de su edad.

Palabras clave:
Bacteriemias
Octogenarios
Edad avanzada
Abstract
Introduction

The aim of our study was to describe the characteristics of bacteremia detected in patients over 79 years and to identify possible factors associated with the mortality.

Methods

A retrospective cohort study, which included all patients over 17 years of age with bacteremia detected between 2004-7 was performed. Demographic variables, comorbidities, source of bacteremia, causing microorganism, severity and hospital mortality were recorded. Patients were classified into three age groups: 18 to 64 years (G1), 65 to 79 (G2) and ≥80 years (G3).

Results

We analyzed 1594 episodes of bacteremia (35% in G1, 35% in G2 and 29% in G3). In G3, 47% had renal failure, 83% solid neoplasm, 2% immunosuppression 5% malnutrition and 38% decubitus ulcers. These proportions were 27, 30, 5 and 2%, respectively in G2, and 15, 16, 12 and 5% in G1 (P<.01). The urinary focus accounted for 28%, 43% and 44% in G1, G2 and G3, respectively (P<.01) and biliary focus 6, 11 and 16% (P<.01), in each group. E. coli accounted for 32% in G1, 44% in G2 and 51% in G3. Mortality in each age group was 9, 16 and 21%. In multivariate analysis, mortality in the ≥80 years was associated with renal failure, malnutrition, the presence of ulcers and shock.

Conclusions

Bacteremia in the elderly are mainly of urinary origin. Mortality in these cases depends primarily on the patient's baseline status rather than their age.

Keywords:
Bacteremia
Octogenarians
The elderly

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