infections in the elderly
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Etiology
- incidence & type of infection varies with functional status
- healthy, independent elderly
- pneumonia*
- bronchitis
- urinary tract infection*
- endocarditis, especially due to Enterococci
- intra-abdominal infections
- recurrent Herpes zoster (shingles)
- frail, debilitated residents of long-term care facilities
- pneumonia secondary to aspiration
- epidemic viral respiratory infections (influenza, RSV)
- urinary tract infections
- skin & other soft tissue infections*
- herpes zoster, cellulitis, pressure ulcer infections, scabies[7]
- epidemic gastroenteritis
- tuberculosis (reactivation)
- hospitalized, acutely ill elderly
- healthy, independent elderly
- microbial etiology in elderly differs from younger patients
* three most common infections in the geriatric population
Epidemiology
- incidence & prevalence
- many types of infections are more common in the elderly
- morbidity & mortality is generally higher in the elderly
Clinical manifestations
- fever may be absent or blunted 20-50% of infections
- elderly may present with hypothermia
- leukocytosis may be absent
- cough & dysuria are less common in the elderly
- atypical presentation of infection is common
- altered mental status
- poor oral intake
- falls
- failure to thrive
Management
- reducing morbidity & mortality for infections
- early recognition/empiric antimicrobial therapy
- asymptomatic bacteriuria requires no treatment
- blood cultures prior to empiric antibiotics
- antibiotic resistance in long-term care facilities
- ongoing surveillance for antibiotic resistance
- molecular typing of isolates when rate of antibiotic resistance increases
- hygiene control to limit spread of single clonal strains
- antibiotic controls to limit spread of multiple strains of antibiotic resistant bacteria
- administrative support, resources, monitoring adherence to control measures with appropriate feedback
- appropriate screening & cohorting of colonized & infected individuals
- 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
- 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
- urinary tract infection without catheter
- ongoing surveillance for antibiotic resistance
- prevention/prophylaxis:
More general terms
More specific terms
Additional terms
- age-associated changes in immunity; immunosenescence
- antibiotic resistance in nursing homes
- antibiotic side effects in the elderly
References
- ↑ Norman D, In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ Internal Medicine World Report 2006; 21(2)
- ↑ 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: https://pubmed.ncbi.nlm.nih.gov/19072244
- ↑ 4.0 4.1 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
- ↑ Esme M, Topeli A, Yavuz BB, Akova M. Infections in the Elderly Critically-Ill Patients. Front Med (Lausanne). 2019 Jun 6;6:118. PMID: https://pubmed.ncbi.nlm.nih.gov/31275937 PMCID: PMC6593279 Free PMC article. Review. https://pmc.ncbi.nlm.nih.gov/articles/PMC6593279/
- ↑ Jump RLP, Crnich CJ, Mody L et al Infectious Diseases in Older Adults of Long-Term Care Facilities: Update on Approach to Diagnosis and Management. J Am Geriatr Soc. 2018 Apr;66(4):789-803. PMID: https://pubmed.ncbi.nlm.nih.gov/29667186 PMCID: PMC5909836 Free PMC article. Review.
- ↑ 7.0 7.1 O'Donnell JA, Hofmann MT. Skin and soft tissues. Management of four common infections in the nursing home patient. Geriatrics. 2001 Oct;56(10):33-8, 41. PMID: https://pubmed.ncbi.nlm.nih.gov/11641861 Review.