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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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Original
Bacteriemias en la población de mayores de 80 años
Bloodstream infection in the up to 80 year-old-patients
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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2011
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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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sin considerar los microorganismos contaminantes&#46; Los hemocultivos se procesaron en el sistema automatizado BacT&#47;Alert<span class="elsevierStyleSup">&#174;</span> &#40;bioM&#233;rieux&#41;&#46; La identificaci&#243;n de los microorganismos se realiz&#243; mediante t&#233;cnicas est&#225;ndar y la sensibilidad antibi&#243;tica mediante sistema VITEK<span class="elsevierStyleSup">&#174;</span> 2 &#40;bioM&#233;rieux&#41; o determinaci&#243;n de la concentraci&#243;n m&#237;nima inhibitoria &#40;CMI&#41; en medio l&#237;quido por t&#233;cnica de microdiluci&#243;n &#40;IZASA&#41;&#44;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Variables</span><p id="par0065" class="elsevierStylePara elsevierViewall">La recogida de variables se realiz&#243; de forma prospectiva por el equipo de microbiolog&#237;a y de control de infecci&#243;n&#44; y fueron revisadas y analizadas <span class="elsevierStyleItalic">a posteriori</span>&#44; 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; <span class="elsevierStyleItalic">b&#41;</span> neutropenia de<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1&#46;000 neutr&#243;filos&#47;dl&#59; <span class="elsevierStyleItalic">c&#41;</span> enfermedad hematol&#243;gica maligna&#59; <span class="elsevierStyleItalic">d&#41;</span> el uso de alg&#250;n inmunosupresor los 30 d&#237;as previos&#59; <span class="elsevierStyleItalic">e&#41;</span> haber sido sometido a cirug&#237;a mayor en los &#250;ltimos 30 d&#237;as&#59; <span class="elsevierStyleItalic">f&#41;</span> infecci&#243;n por VIH&#59; <span class="elsevierStyleItalic">g&#41;</span> insuficiencia renal cr&#243;nica terminal o en di&#225;lisis&#59; <span class="elsevierStyleItalic">h&#41;</span> cirrosis&#59; e <span class="elsevierStyleItalic">i&#41;</span> antecedentes de esplenectom&#237;a&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Estado nutricional</span><p id="par0095" class="elsevierStylePara elsevierViewall">Se valor&#243; como &#171;adecuado&#187; si las cifras de alb&#250;mina eran superiores a 3<span class="elsevierStyleHsp" style=""></span>g&#47;dl o &#171;inapropiado&#187; si eran menores&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">&#218;lceras por dec&#250;bito</span><p id="par0105" class="elsevierStylePara elsevierViewall">Se registr&#243; su presencia o ausencia y se utiliz&#243; como par&#225;metro indirecto de la situaci&#243;n basal funcional del enfermo&#44; considerando una situaci&#243;n de dependencia alta en aquellos pacientes con &#250;lceras&#46; El registro se realiz&#243; en el momento en que el hemocultivo fue positivo&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Sonda urinaria permanente</span><p id="par0115" class="elsevierStylePara elsevierViewall">Se recogi&#243; a trav&#233;s de los antecedentes personales que constaban en la historia cl&#237;nica&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Foco de bacteriemia</span><p id="par0125" class="elsevierStylePara elsevierViewall">Se clasificaron como respiratorio&#44; 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; <span class="elsevierStyleItalic">a&#41;</span> de origen comunitario&#44; cuando el paciente con bacteriemia viene directamente de domicilio&#59; <span class="elsevierStyleItalic">b&#41;</span> de origen nosocomial&#44; cuando el enfermo presenta un hemocultivo positivo transcurrido al menos tiempo total de ingreso hospitalario de 48 h&#44; o bien&#44; cuando lleven menos de 48 h&#44; pero que hayan estado ingresados en cualquier centro hospitalario durante los 10 d&#237;as previos&#59; y <span class="elsevierStyleItalic">c&#41;</span> relacionadas con la atenci&#243;n sanitaria cuando a lo largo de los 30 d&#237;as previos al hallazgo de bacteriemia el paciente haya vivido en un centro sociosanitario o en una residencia&#44; haya recibido atenci&#243;n en un centro de hemodi&#225;lisis o cualquier tratamiento endovenoso en r&#233;gimen de hospital de d&#237;a&#44; haya estado recibiendo tratamiento endovenoso&#44; curas&#44; nutrici&#243;n enteral o cuidados m&#233;dicos o de enfermer&#237;a en r&#233;gimen de hospitalizaci&#243;n domiciliaria o haya tenido una hospitalizaci&#243;n de m&#225;s de 48 h de duraci&#243;n en los 90 d&#237;as previos a la fecha de la toma del hemocultivo que result&#243; 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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        0 => array:2 [
          "identificador" => "xres15980"
          "titulo" => array:5 [
            0 => "Resumen"
            1 => "Introducci&#243;n"
            2 => "Material y m&#233;todos"
            3 => "Resultados"
            4 => "Conclusiones"
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        1 => array:2 [
          "identificador" => "xpalclavsec18252"
          "titulo" => "Palabras clave"
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        2 => array:2 [
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          "titulo" => array:5 [
            0 => "Abstract"
            1 => "Introduction"
            2 => "Methods"
            3 => "Results"
            4 => "Conclusions"
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        3 => array:2 [
          "identificador" => "xpalclavsec18253"
          "titulo" => "Keywords"
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        4 => array:2 [
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          "titulo" => "Introducci&#243;n y objetivos"
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        5 => array:3 [
          "identificador" => "sec0020"
          "titulo" => "Pacientes y m&#233;todos"
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            0 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Dise&#241;o y &#225;mbito"
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            1 => array:2 [
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              "titulo" => "Pacientes"
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            2 => array:3 [
              "identificador" => "sec0035"
              "titulo" => "Variables"
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                0 => array:2 [
                  "identificador" => "sec0040"
                  "titulo" => "Comorbilidades"
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                1 => array:2 [
                  "identificador" => "sec0045"
                  "titulo" => "Inmunosupresi&#243;n"
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                2 => array:2 [
                  "identificador" => "sec0050"
                  "titulo" => "Estado nutricional"
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                3 => array:2 [
                  "identificador" => "sec0055"
                  "titulo" => "&#218;lceras por dec&#250;bito"
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                4 => array:2 [
                  "identificador" => "sec0060"
                  "titulo" => "Sonda urinaria permanente"
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                5 => array:2 [
                  "identificador" => "sec0065"
                  "titulo" => "Foco de bacteriemia"
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                6 => array:2 [
                  "identificador" => "sec0070"
                  "titulo" => "Origen de la bacteriemia"
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                7 => array:2 [
                  "identificador" => "sec0075"
                  "titulo" => "Evoluci&#243;n"
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            3 => array:2 [
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              "titulo" => "An&#225;lisis estad&#237;stico"
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          "titulo" => "Resultados"
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        7 => array:2 [
          "identificador" => "sec0090"
          "titulo" => "Discusi&#243;n y conclusiones"
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        8 => array:2 [
          "identificador" => "sec0095"
          "titulo" => "Conflicto de intereses"
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        9 => array:2 [
          "identificador" => "xack1451"
          "titulo" => "Agradecimientos"
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        10 => array:1 [
          "titulo" => "Bibliograf&#237;a"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-12-11"
    "fechaAceptado" => "2012-02-25"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec18252"
          "palabras" => array:3 [
            0 => "Bacteriemias"
            1 => "Octogenarios"
            2 => "Edad avanzada"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec18253"
          "palabras" => array:3 [
            0 => "Bacteremia"
            1 => "Octogenarians"
            2 => "The elderly"
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      ]
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    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "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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                  \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">&nbsp;\t\t\t\t\t\t\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" 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"><span class="elsevierStyleItalic">Edad</span>&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"><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">0&#44;001&nbsp;\t\t\t\t\t\t\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">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">&#8212;&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"><span class="elsevierStyleHsp" style=""></span>Insuficiencia renal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;002&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
                  \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
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                  \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
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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">&#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
                  \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
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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
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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
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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
                  \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></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>Desnutrici&#243;n&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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;99 &#40;1&#44;66-5&#44;37&#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">3&#44;8 &#40;1&#44;5-9&#44;5&#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;04&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>&#218;lceras dec&#250;bito&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
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                  \t\t\t\t">3&#44;13 &#40;1&#44;91-5&#44;14&#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">2&#44;4 &#40;1&#44;1-5&#44;3&#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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;02&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
                  \t\t\t\t\ttop\n
                  \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\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&#44;41 &#40;1&#44;13-5&#44;13&#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\ttop\n
                  \t\t\t\t">0&#44;022&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\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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8212;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sonda vesical&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">1&#44;63 &#40;1&#44;09-2&#44;45&#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\ttop\n
                  \t\t\t\t">0&#44;017&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\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
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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\ttable-entry\n
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                  \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  " colspan="5" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gravedad cl&#237;nica</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="elsevierStyleHsp" style=""></span>Shock&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><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">4&#44;0 &#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
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                  \t\t\t\t\ttop\n
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                  \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  " colspan="5" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Foco</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="elsevierStyleHsp" style=""></span>Urinario&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
                  \t\t\t\t\ttop\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\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;2 &#40;0&#44;1-0&#44;3&#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
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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>Biliar&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
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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
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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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;2 &#40;0&#44;1-0&#44;5&#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>Respiratorio&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;79 &#40;1&#44;12-2&#44;87&#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;014&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>No identificado&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">2&#44;52 &#40;1&#44;63-3&#44;90&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vascular&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">2&#44;73 &#40;1&#44;05-7&#44;09&#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;039&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  " colspan="5" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Microorganismo</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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">E&#46; coli</span>&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;55 &#40;0&#44;37-0&#44;81&#41;&nbsp;\t\t\t\t\t\t\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"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&nbsp;\t\t\t\t\t\t\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"><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><span class="elsevierStyleItalic">E&#46; coli</span>&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\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">&#37;&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">N&#250;mero&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">&#37;&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">N&#250;mero&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">&#37;&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">18-64&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">65-79&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
                  \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
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">558&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="left" valign="\n
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                  \t\t\t\t">35&#44;0&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">567&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">35&#44;6&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">469&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;4&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">versus &#8805;<span class="elsevierStyleHsp" style=""></span>80</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">Edad-mediana</span> &#40;rango&#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
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                  \t\t\t\t">52&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;18-64&#41;&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">73&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;65-79&#41;&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">84&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;80-99&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&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="elsevierStyleItalic">Sexo&#44; var&#243;n</span>&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">348&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">62&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">333&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&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">223&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&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="left" 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="left" 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  " colspan="9" 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  " colspan="9" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidades</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="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">86&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&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">152&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&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">150&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="left" valign="\n
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                  \t\t\t\t">32&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="left" 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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \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>Diabetes&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">81&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14&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">188&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="left" valign="\n
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                  \t\t\t\t">33&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">125&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \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>Neoplasia s&#243;lida&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">92&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="left" valign="\n
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                  \t\t\t\t">16&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">168&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="left" valign="\n
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                  \t\t\t\t">30&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">83&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&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="left" 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="left" 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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&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">35&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&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">17&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="left" valign="\n
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                  \t\t\t\t">4&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="left" 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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \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>Enf&#46; resp&#46; cr&#243;nica&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">42&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
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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>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>Shock&nbsp;\t\t\t\t\t\t\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  " align="left" valign="\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\ttable-entry\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
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \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\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\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</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">49&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">NS&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="left" valign="\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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No filiada&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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ISSN: 00142565
Idioma original: Español
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