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infections in the elderly

Etiology: 1) incidence & type of infection varies with functional status a) healthy, independent elderly - pneumonia* - bronchitis - urinary tract infection* - endocarditis, especially due to Enterococci - intra-abdominal infections - diverticulitis - cholangitis - recurrent Herpes zoster (shingles) b) frail, debilitated residents of long-term care facilities - pneumonia secondary to aspiration - dysphagia - feeding gastrostomy - epidemic viral respiratory infections (influenza, RSV) - urinary tract infections - catheter-associated urinary tract infection - urinary retention - skin & other soft tissue infections* - epidemic gastroenteritis - tuberculosis (reactivation) c) hospitalized, acutely ill elderly - urinary tract infection - urinary catheter infections - pneumonia -> aspiration - catheter-related infections - wound infections - surgery - diabetes mellitus - vascular disease 2) microbial etiology in elderly differs from younger patients * three most common infections in the geriatric population Epidemiology: - incidence & prevalence a) many types of infections are more common in the elderly b) morbidity & mortality is generally higher in the elderly Clinical manifestations: 1) fever may be absent or blunted 20-50% of infections 2) leukocytosis may be absent 3) atypical presentation of infection is common a) altered mental status b) falls c) failure to thrive Management: 1) reducing morbidity & mortality for infections in the elderly - prevention (prophylaxis) - early recognition/empiric antimicrobial therapy - asymptomatic bacteriuria requires no treatment 2) antibiotic resistance in long-term care facilities a) ongoing surveillance for antibiotic resistance - molecular typing of isolates when rate of antibiotic resistance increases b) hygiene control to limit spread of single clonal strains c) antibiotic controls to limit spread of multiple strains of antibiotic resistant bacteria d) administrative support, resources, monitoring adherence to control measures with appropriate feedback e) appropriate screening & cohorting of colonized & infected individuals f) minimal criteria for initiation of antibiotic therapy in long-term care facilities [4] - urinary tract infection without catheter - fever & - new or worsening of urinary frequency, urinary urgency, or urinary incontinence, or - suprapubic pain, or - gross hematuria, or - costovertebral angle tenderness - urinary tract infection with catheter - fever or - costovertebral angle tenderness, or - rigors, or - new-onset delirium - skin infection or soft tissue infection - fever or erythema, tenderness, warmth or swelling of affected site - respiratory tract infection - fever >= 38.9 C and respiratory rate > 25/min or productive cough - fever > 37.8-39.9 C and respiratory rate > 25/min or pulse > 100/min or rigors or new-onset delirium - afebrile with COPD and new or increased cough with purulent sputum - afebrile without COPD and new or increased cough & respiratory rate > 25 or new-onset delirium - fever of unknown origin - new onset delirium or rigors - antibiotics not recommended as a diagnostic test - if initiated as such, discontinue after 3-5 days if no improvement & workup for infection is negative 3) prevention/prophylaxis: - influenza vaccination (patients & health care workers) - Pneumovax - tetanus immunization - hepatitis B vaccination

Related

age-associated changes in immunity; immunosenescence antibiotic resistance in nursing homes antibiotic side effects in the elderly

Specific

infectious arthritis in the elderly infectious outbreaks in nursing homes

General

infection (infectious disease) geriatric disorder; disease of old age; geriatric syndrome

References

  1. Norman D, In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  2. Internal Medicine World Report 2006; 21(2)
  3. High KP et al, Clinical practice guidelines for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Disease Society of America. Clin Infect Dis 2009, 48:149 PMID: 19072244
  4. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013