Rıdvan DUMLU, Ali MERT
European Journal of Geriatrics and Gerontology - 2026;8(2):108-114
Objective: Carbapenem-resistant Enterobacterales bloodstream infections (CRE-BSIs) are associated with increased mortality, particularly among older adults. This study aimed to evaluate clinical severity, treatment-related factors, and geriatric vulnerability parameters associated with 30-day mortality in patients aged >=65 years. Materials and Methods: Patients aged 65 and older who were diagnosed with a BSI caused by CRE between 2016 and 2025 were included in this retrospective cohort study. Demographic, clinical, microbiological, and treatment-related data were collected. Geriatric vulnerability was assessed using the Hospital Frailty Risk Score (HFRS), the Geriatric Nutritional Risk Index (GNRI), polypharmacy, and functional dependency. To determine the factors associated with 30-day mortality, a Cox regression analysis was performed. Results: Of the 177 patients included in the study, the 30-day mortality rate was 35.6%. The multivariate analysis revealed that a higher Pitt Bacteremia Score [adjusted hazard ratio (HR) = 1.24, 95% confidence interval (CI) 1.12-1.37, p < 0.001], a higher HFRS score (aHR = 1.12, 95% CI 1.04-1.21, p = 0.002), and a delay in appropriate treatment (>=72 hours) (aHR = 2.01, 95% CI 1.25-3.24, p = 0.004) was independently associatedwith increased mortality. GNRI was inversely associated with mortality (aHR = 0.96, 95% CI 0.93-0.99, p = 0.008). Chronological age and antimicrobial treatment type were not independently associated with mortality in the multivariable analysis. Conclusion: Mortality in older adults with CRE-BSIs may be largely explained by infection severity and biological vulnerability rather than chronological age. Frailty and impaired nutritional status appear to be important determinants of outcome, while delayed initiation of appropriate therapy remains a critical modifiable factor.
