{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T19:07:23Z","timestamp":1788894443701,"version":"build-2803163510"},"reference-count":0,"publisher":"Journal of Infection in Developing Countries","issue":"08","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Infect Dev Ctries"],"abstract":"<jats:p>Introduction: Sepsis epidemiology varies regionally. We aimed to characterise community-acquired sepsis in Chinese older adults and develop an evidence-based, cost-effective empirical therapeutic pathway tailored to local antimicrobial-resistance patterns.\nMethods: This single-centre, retrospective observational cohort study conducted at a tertiary hospital in Shanghai, China, enrolled 122 consecutive older adults (age \u2265 65 years) meeting Sepsis-3 criteria between June 2021 and May 2023. Microbiological data, antimicrobial-susceptibility profiles, clinical characteristics, and 28-day all-cause mortality were analysed. Multivariate logistic regression was used to identify independent risk factors for mortality.\nResults: Gram-negative bacteria predominated (54.9%) and showed high susceptibility to cefoperazone-sulbactam (85.0%). The 28-day mortality rate was 37.7%. Multivariate analysis identified increasing age (adjusted odds ratio [aOR] = 1.10 per year), need for intensive care unit admission (aOR = 6.65), mechanical ventilation (aOR = 5.78), and dialysis (aOR = 3.62) as independent predictors of mortality. Notably, adequate empirical antimicrobial therapy was not an independent protective factor in the adjusted model. A cost-effective clinical pathway with cefoperazone-sulbactam as the first-line empirical therapy and escalation based on clinical response was developed for use in resource-limited settings.\nConclusions: The findings underscore the dominance of Gram-negative pathogens and the critical influence of host factors on survival among older adults with sepsis in China. They also provide a carbapenem-sparing, pragmatic, and sustainable management pathway for initial sepsis treatment in resource-limited settings, which can be replicated for antimicrobial stewardship in other regions with similar epidemiological profiles. The clinical effectiveness of this hypothesis-generating pathway requires validation in prospective, multicentre studies..<\/jats:p>","DOI":"10.3855\/jidc.22560","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T18:34:22Z","timestamp":1788892462000},"page":"1161-1170","source":"Crossref","is-referenced-by-count":0,"title":["A proposed management pathway for community-acquired Gram-negative sepsis in Chinese older adults"],"prefix":"10.3855","volume":"20","author":[{"given":"Liling","family":"Jing","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiwei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunlong","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2222","published-online":{"date-parts":[[2026,8,31]]},"container-title":["The Journal of Infection in Developing Countries"],"original-title":[],"link":[{"URL":"https:\/\/www.jidc.org\/index.php\/journal\/article\/download\/22560\/3942","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.jidc.org\/index.php\/journal\/article\/download\/22560\/3942","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T18:34:22Z","timestamp":1788892462000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jidc.org\/index.php\/journal\/article\/view\/22560"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":0,"journal-issue":{"issue":"08","published-online":{"date-parts":[[2026,8,31]]}},"URL":"https:\/\/doi.org\/10.3855\/jidc.22560","relation":{},"ISSN":["1972-2680"],"issn-type":[{"value":"1972-2680","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]}}}