Infection In Elderly Patients Research Articles

Infection in the elderly--what is different?

Infectious diseases are a common cause of increased morbidity and mortality in elderly patients and present a frequent problem in the geriatrician's daily practice. Infections in the elderly are quite different from infections in a younger population. These differences are due to Age-related alterations in immunology Different epidemiology and bacteriology Increased morbidity and mortality Altered clinical presentation Concommittant disability and comorbidity in many older patients Different approaches to therapy. This article is an attempt to discuss these various aspects of infectious disease in the elderly. The most important infections in the elderly are caused by bacteria. Incidence and bacterial spectrum depends on the site of infection and whether the patient is hospitalized, living in a nursing home or in the community. Pneumonia, UTI and pressure ulcer infections are more frequent in patients living in nursing homes than in community dwelling older people. Infections are a frequent cause of hospitalization in elderly people and hospitalization on the other hand is a risk factor for life-threatening nosocomial infections, caused by invasive diagnostic procedures and frequent use of urinary and venous catheters. Infections in the elderly are often accompanied by serious complications as bacteriemia (pneumonia), frequent recurrence (UTI), perforation and abscess (abdominal infections) and severe disability (pressure ulcer infections). Because of these serious and frequent complications mortality of infections is higher in older patients than in younger people. Elderly patients with infectious disease often present in the same way as younger patients do. Many elderly however present with non-specific clinical symptoms and non-specific functional decline which makes an accurate diagnosis difficult and may lead to a life-threatening delay of diagnosis and therapy. In older patients with unexplained functional decline, physicians must be aware of the possibility of a serious infection. Moreover, the physician can not rely on typical signs of infections as fever. In the elderly the fever response is often blunted even in the presence of bacteremia. Leokocytosis may be absent and elevation of acute phase protein is a more reliable marker of infection than elevation of erythrocyte sedimentation rate. Clinical suspicion of bacterial infection in elderly patient should prompt Careful anamnesis and clinical investigation Hospitalization if necessary Diagnostic procedures without delay including blood cultures Immediate empiric antibiotic therapy taking into account the site of infection, if the infection is community acquired or nosocomial and the most likely bacterial spectrum and local resistance factors. The use of broad spectrum antibiotic substances with a low side effect profile and pharmacokinetic properties which are suitable for elderly patients.

Infections in elderly patients

There is considerable debate as to the effects of aging on the susceptibility of old people to infection, and the extent to which this modifies the signs and symptoms of infection. Factors that may be of even greater importance are the effects of poor nutrition, multiple pathology and polypharmacy on their response to infection, and the effectiveness of their immune systems.

高齢者のＭＲＳＡ感染症に対するＶａｎｃｏｍｙｃｉｎ Ｈｙｄｒｏｃｈｌｏｒｉｄｅの使用法

Objectives: A dose of vancomycin should be reduced for treatment of methicillinresistant Staphylococcus aureus (MRSA) infections in elderly patients with decreased renal function to avoid nephrotoxicity and ototoxicity. By adjusting doses and dosing intervals with therapeutic drug monitoring (TDM), we studied the most appropriate use of vancomycin in 6 elderly patients with MRSA infections.Method: The dosage-regimen was as follows: Vancomycin was abministered intravenously over 60 min at a dose of 0.5 g, b.i.d. in all patients. The same dosage-regimen was maintained when the trough vancomycin concentration was less than 10 μg/ml on the 3rd day with TDM. If the trough concentration was≥10μg/ml, 0.5 g of vancomycin was given once daily. Three days after a change of dosing interval, the dose of vancomycin was reduced to 0.25 g if the trough concentration was≥10μg/ml with TDM, otherwise the second dosage-regimen was maintained. The primary endpoint was disappearance of MRSA and the second was improvement of clinical findings (CRP, body temperature, white cell count).Results: MRSA disappeared in all patients. Adjustment of the dosage-regimen was made in 4 out of 6 patients through the treatment. The global improvement rating was 83.3% in this study. Adverse events included the mild increase of serum GOT, GPT and ALP in only one patient. The values of these enzymes returned to normal range after cessation of the antibiotic without additional medical treatment.Conclusion: We recommend a dosage-regimen of vancomycin of 0.5 g, b.i.d. at the start of treatment of MRSA infections in elderly patients. TDM should be performed after steady-state vancomycin concentration is reached (usually 3 days after the start of treatment) in order to assure efficacy and safety of the antibiotic. Patients with decreased renal function (CLCR≤40 ml/min) should be treated with a much lower dose or a longer interval from the start of treatment, and TDM is strongly recommended for those patients.

老年者消化性潰ようにおけるＨｅｌｉｃｏｂａｃｔｅｒ ｐｙｌｏｒｉ感染 内視鏡的胃粘膜性状との関連を含めて

I examined the characteristics of Helicobacter pylori (H. pylori) infection in elderly patients with peptic ulcer and its relation to the endoscopic appearance of the gastric mucosa. 1) Infection with H. pylori was more common in middle-aged patients (those over 40 and younger than 59 years old, 80.4%) than in younger patients (those less than 39 years old, 63.0%). Elderly patients were less likely than younger patients to be infected (60's: 77.7%, 70's: 70.8%, over 80 years old: 65.8%). The percentage was higher in men than in women, in all age groups. 2) Oshima's classification was used to divide the patients into 5 groups, according to the endoscopic appearance of blood vessels of the gastric mucosa. Infection was found in 71.7% of the patients without atrophy, in 86.3% of those with mild atrophy, and in 88.9% of those with moderate atrophy. In contrast, infection was found in only 78.4% of the patients with severe atrophy. Similar results were found in patients with peptic ulcer and in subjects with no lesion except atrophic gastritis. 4) The percentage of patients with gastric ulcer disease who had atrophic gastric mucosa was higher in those with ulcers above the middle of the stomach (46.3%) than in those with ulcers in the antrum (30.2%, p < 0.05). Almost all patients with gastric ulcers in the lower part of the stomach and in the angulus were found to be infected with H. pylori (93.3% and 94.0%, respectively). The percentage of patients with ulcers low in the stomach who were infected was lower (59.4%). All of the location-related differences in infection were significant (p < 0.001).

Optimal Treatment of Urinary Tract Infections in Elderly Patients

Elderly patients are at high risk for urinary tract infection (UTI). Infections of the urinary tract may be classified as asymptomatic bacteriuria, uncomplicated cystitis, uncomplicated pyelonephritis or complicated UTI. The micro-organisms responsible for causing UTI are largely predictable and dictate therapy when indicated. UTIs may be diagnosed by both nonculture and culture techniques. Asymptomatic bacteriuria, though quite common in the elderly, should rarely be treated. Treatment of symptomatic uncomplicated and complicated UTIs is largely dictated by the known or expected pathogen(s) and classification of the infection. Additional features affecting the treatment of UTI in the elderly include allergies, adverse reactions to therapy, drug interactions and modification for renal insufficiency.

Efficacy of sulbactam/cefoperazone in respiratory tract infections in elderly patients with underlying respiratory diseases

We examined the clinical effect of sulbactam/cefoperazone (SBT/CPZ) on respiratory tract infections in elderly patients (from 65 to 91, average 70.8) with underlying respiratory diseases. Thirty (30) patients (25 men and 5 women) were registered and SBT/CPZ (2 g/day) divided into two doses, was administered intravenously through drip infusion. The efficacy rate was 63% (excellent in 1 patient and good in 18 patients). No significant difference in efficacy was found among patient's age groups (group 1: 65-69, group 2: 70-74, group 3: 75-79, group 4: > 80). Bacterial eradication rate was 50% (6 out of 12 strains). An adverse reaction occurred in one patient, who experienced uticaria. Laboratory abnormalities, which were increasing with their ages, were observed in 12 patients during the study. These results suggest that SBT/CPZ was effective, but we found it is important to use caution in the treatment of elderly patients on respiratory tract infections with underlying respiratory diseases.

Clinical isolates of group B streptococci from elderly patients

The importance of Group B streptococcal infection in elderly patients has not been clearly defined. We studied the annual incidence of Group B streptococci (GBS) isolated from sputum and urine of elderly patients who were admitted to Nagoyashi Koseiin Geriatric Hospital. The percentage of GBS isolated has increased since 1988. The type distribution of GBS isolates shows predominantly types Ia, Ib and JM9. The major clinical factors in patients from whom GBS was isolated from sputum were bedridden status, feeding tubes and tracheostomy. We also investigated the antibody to GBS in these elderly patients. The titers of GBS antibody were significantly higher in the group with GBS isolates than in the group without these pathogens. These results suggest that GBS is one of the causative organisms of nosocomial infections in elderly patients.

Delay in the diagnosis of bacteraemic urinary tract infection in elderly patients.

Collaboration between clinicians and microbiologists revealed that many patients with subsequently proven urinary tract infection (UTI) present with symptoms suggestive of chest infection. A retrospective analysis was performed on patients over 50 years old with community acquired bacteraemic UTI proven by blood cultures. The main presenting features were confusion (30%), cough (27%), dyspnoea (28%) and new urinary symptoms (20%). The initial clinical diagnosis was UTI in 43% and chest infection in 24%. Chest infection was diagnosed more often in those over 70 years old than those aged 50-70 years old (chi 2 = 7.2, p = 0.007). The majority had pyuria but less than half of the urine samples arrived in the laboratory on the day of admission, fewer from the older patients than the younger (chi 2 = 2.57, p = 0.10). These results demonstrate that UTI frequently presents with respiratory features and that the diagnosis of UTI is often delayed. Sampling the urine with a catheter may be justified to enable diagnosis on the day of admission.

An automated high volume assay to screen for inhibitors of myo-inositol monophosphatase from microbial fermentation broths.

We examined the clinical effect of sulbactam/cefoperazone (SBT/CPZ) on respiratory tract infections in elderly patients (from 65 to 91, average 70.8) with underlying respiratory diseases. Thirty (30) patients (25 men and 5 women) were registered and SBT/CPZ (2 g/day) divided into two doses, was administered intravenously through drip infusion. The efficacy rate was 63% (excellent in 1 patient and good in 18 patients). No significant difference in efficacy was found among patient's age groups (group 1: 65-69, group 2: 70-74, group 3: 75-79, group 4: > 80). Bacterial eradication rate was 50% (6 out of 12 strains). An adverse reaction occurred in one patient, who experienced uticaria. Laboratory abnormalities, which were increasing with their ages, were observed in 12 patients during the study. These results suggest that SBT/CPZ was effective, but we found it is important to use caution in the treatment of elderly patients on respiratory tract infections with underlying respiratory diseases.

ANTIBIOTIC CONCERNS IN THE ELDERLY: A Clinician's Perspective

Unique antibiotic concerns exist for the management of infections in elderly patients. Issues concerning age-associated physiological alterations, compliance, drug-drug interactions, adverse drug reactions, and guidelines for empiric therapy are reviewed in this article.

Infections in elderly patients associated with impacted third molars

The objective of this study was to determine the clinical characteristics of infections caused by impacted third molars in elderly persons. Infectious disorders (26 pericoronitis, 8 secondarily infected dentigerous cysts, 4 perimandibular abscesses with limited osteomyelitis, 2 chronic mandibular osteomyelitis, and 1 odontogenic skin fistula) associated with the impacted third molars impacted third molars were clinically investigated in 41 patients over 60 years of age. Twenty-nine causative teeth were located in the mandibular angle and nine in the ramus; the three remaining lesions (two cysts one pericoronitis) were associated with the maxillary third molar. Bone resorption was noted in most patients, and this caused the originally embedded tooth to become exposed intraorally. It was concluded that oral infection in elder persons are occasionally caused by retained impacted third molars with overlapping of other factors.

Hepatitis C virus infection in elderly patients

Hepatitis C virus infection in elderly patients

Risk Factors for Acquisition of Urinary Tract Infections Caused by Ciprofloxacin Resistant Escherichia Coli

From January 1990 to December 1992, ciprofloxacin resistant Escherichia coli was isolated in 125 of 1,946 urine cultures (6.4%) with more than 10(5) colony-forming units per ml. To determine the risk factors for acquisition of urinary tract infections caused by ciprofloxacin resistant E. coli a retrospective chart review was done. Data from 54 patients with urinary tract infections caused by ciprofloxacin resistant E. coli were compared with 51 controls matched by temporal occurrence and randomly selected among 540 patients with urinary tract infections caused by ciprofloxacin susceptible E. coli. Patients had greater proportions of asymptomatic bacteriuria or lower urinary tract symptoms (85% versus 61%, p = 0.01) and of relapse (22% versus 0%, p = 0.001) than controls. Urinary tract abnormalities (odds ratio 7.98, 95% confidence interval 2.7 to 3.1, p < 0.001), patient age 65 years or older (odds ratio 6.48, 95% confidence interval 2.2 to 19.1, p < 0.001), previous treatment with quinolones (odds ratio 19.09, 95% confidence interval 2.2 to 166.5, p = 0.008) and urinary catheterization (odds ratio 2.92, 95% confidence interval 1.1 to 8.5, p = 0.048) were independently associated with infections caused by ciprofloxacin resistant strains. Our results suggest that patients with urological abnormalities previously treated with quinolones are especially prone to urinary tract infection caused by ciprofloxacin resistant strains.

Treatment of infections in elderly patients

Infections are common in elderly persons. The clinical manifestations of infection may be atypical or absent in the elderly. The microbial cause for many common infections may be more diverse in elderly patients, and obtaining diagnostic clinical specimens often is more difficult. Aging is associated with changes in pharmacokinetics and a higher rate of adverse drug reactions. These factors impact on the approach to treating infections in the elderly.

Book Reviews

Journal Article Book Reviews Get access Infections in Elderly Patients, W. J. MacLennan , B. Watt and A. T. Elder , London: Edward Arnold; distributed by Bookpoint Ltd., Abingdon, Oxon. 1994. 165 pp. Price £24.99 (hardback). JOHN BENDALL JOHN BENDALL Geriatrician Nottingham Search for other works by this author on: Oxford Academic PubMed Google Scholar Age and Ageing, Volume 24, Issue 3, May 1995, Page 261, https://doi.org/10.1093/ageing/24.3.261-a Published: 01 May 1995

Ciprofloxacin

Ciprofloxacin belongs to the fluoroquinolone class of antimicrobial agents which primarily inhibit bacterial DNA gyrase. It is effective after oral or intravenous administration, demonstrating potent antibacterial activity against most Gram-negative, and many Gram-positive bacteria. Although most bacterial strains have remained susceptible to the drug, low rates of resistance have been observed in some strains of Pseudomonas aeruginosa and enterococci and higher rates in methicillin-resistant Staphylococcus aureus. Ciprofloxacin attains concentrations in most tissues and body fluids sufficient to inhibit the majority of susceptible pathogens. Its pharmacokinetic profile in the elderly (> or = 65 years) is broadly similar to that reported in younger persons, although plasma concentrations are higher, and renal clearance is decreased in elderly persons. Ciprofloxacin is an effective treatment for those infections most common in elderly patients, including infections of the urinary tract, lower respiratory tract, skin and soft-tissues, and bone and joints, and is an effective agent for prophylaxis in transurethral surgery. Orally administered ciprofloxacin appeared to be at least as effective as alternative orally administered antimicrobial agents (trimethoprim, cotrimoxazole [trimethoprim/sulfamethoxazole], amoxicillin, amoxicillin/clavulanic acid) and also as effective as various parenteral agents (ceftriaxone, cefamandole, ceftazidime, cefotaxime) in a small number of comparative clinical trials. However, further studies are needed to clarify the comparative efficacy of ciprofloxacin with that of other oral and parenteral agents in the elderly. Initial trials have also indicated therapeutic efficacy of oral ciprofloxacin in malignant external otitis and bacterial prostatitis. Nevertheless, with its good tolerability profile and potent antimicrobial activity following oral administration, ciprofloxacin appears to offer a valuable alternative for treating various acute and chronic infections in elderly patients. Causative pathogens are frequently multiresistant in this patient group, and ciprofloxacin avoids or minimises the need for parenteral therapy.

Bactericidal clothes reduce infections in elderly bed-bound nursing home patients

Infections in elderly bed-bound nursing home patients are serious care problems. In order to protect against infections we adopted bactericidal clothes (Sanmo Co., Kyoto, Japan). First, we studied how bactericidal clothes sterilise bacteria in vitro. The bactericidal clothes kill methicillin-resistant Staphylococcus aureus (MRSA), E. Coli, Krebsiella and Pseudomonas aureus, over 99%, 3 h after contact, while these bacteria can survive over 18 h on conventional cotton clothes. Second, ninety elderly patients were divided into two groups; the control group and the “treated” group with bactericidal clothes. In Period 1 neither group received particular treatment for three months and in Period 2 only the treated group used bactericidal clothes for three months. The control group in Period 2 used regular clothes throughout. The number of febrile days was significantly lower for the treated group, compared with the control group. It is suggested that the bactericidal clothes reduce infections in elderly patients.

Chronic Urinary Tract Infections in Elderly Patients

Chronic Urinary Tract Infections in Elderly Patients

The aging immune system and common infections in elderly patients.

The number of elderly persons in the United States has increased to 12.5% of the population, and diseases affecting this age group have also risen. Infections of the respiratory, urinary, and integumentary systems, commonly seen in elderly patients, are a leading cause of death. Changes in the immune system cannot be prevented; however, nursing interventions may reduce the incidence of infection. An understanding of the changes in the immune system and careful nursing assessments may help the nurse to detect infections in elderly patients earlier.

Role of serology in monitoring treatment for Helicobacter pylori infection in elderly patients.

Fifteen elderly patients with type B gastritis caused by Helicobacter pylori infection were treated with triple therapy consisting of colloidal bismuth subcitrate, amoxycillin and metronidazole. All were followed up every 6 weeks for 3 months. After triple therapy, eradication of the infection was confirmed in 12 patients (85%) by histology and bacteriology. In this group, a significant reduction in IgG antibody levels against H. pylori was detected (p < 0.001). In a control group of 15 patients with type B gastritis who received no antibacterial treatment, the specific IgG antibody titre remained unchanged during 3 months of follow-up. We conclude that this simple and noninvasive serological test would be suitable for follow-up after treatment of H. pylori infection in elderly patients.