Infection In Elderly Patients Research Articles

Aging, But Not Sex and Genetic Diversity, Impacts the Pathobiology of Bacterial Endophthalmitis.

PurposeAge, sex, and genetics are important biological variables in determining an individual's susceptibility or response to infectious agents; however, their role has not been evaluated in intraocular infections. In this study, we comprehensively examined the impact of these host biological factors in the pathogenesis of experimental bacterial endophthalmitis.MethodsEndophthalmitis was induced by intravitreal injection of bacteria (Staphylococcus aureus) in the eyes of male and female C57BL/6 mice of different ages: group I (young, 6–8 weeks), group II (mid-age, 18–20 weeks), and group III (old, 1 year). Highly heterogeneous outbred J:DO mice were used for genetic diversity analysis. Eyes were subjected to clinical examination, retinal function testing using electroretinography (ERG), histopathological analysis (hematoxylin and eosin staining), and bacterial burden estimation. The levels of inflammatory mediators were measured using qPCR and ELISA, and the infiltration of neutrophils was determined by flow cytometry.ResultsBoth inbred C57BL/6 and diversity outbred (J:DO) mice were equally susceptible to S. aureus endophthalmitis, as evidenced by a time-dependent increase in clinical scores, bacterial burden, intraocular inflammation, and retinal tissue damage, in addition to decreased retinal function. However, no significant differences were observed in disease severity and innate responses in male versus female mice. Older mice (group III) exhibited higher clinical scores coinciding with increased bacterial proliferation and intraocular inflammation, resulting in enhanced disease severity. Moreover, bone-marrow-derived macrophages from old mice exhibited reduced phagocytic activity but increased inflammatory response toward S. aureus challenge.ConclusionsAge, but not sex, is an important biological variable in bacterial endophthalmitis. Identification of pathways underlying altered innate immunity and impaired bacterial clearance in aging eyes could provide new insights into the pathobiology of intraocular infections in elderly patients.

Prevalence of influenza and viral co-pathogens with severe acute respiratory infection visiting at tertiary care hospital in Nepal

Background: Respiratory infections are one of the major public health problems in Nepal. Data on prevalence and seasonality of respiratory viruses are poorly characterized and hence empirical antimicrobial agents are used in Nepal. The objective of this study was to describe the prevalence and seasonality of influenza and viral co-pathogen in elderly patients with severe acute respiratory infection. Methods and materials: A descriptive cross sectional study was conducted at Central Diagnostic Laboratory and Research Center, Nepal during the year 2017/018. A total of 882 throat & nasopharyngeal swab were collected from patient with severe acute respiratory infection (SARI) according to WHO case definition. Total nucleic acid was extracted using Pure Link viral RNA/DNA mini kit (Invitrogen) and multiplex RT-PCR assays were performed. Results: Of the total 882 specimens; respiratory viruses were found in 556 (63.0%) specimens. Human metapneumovirus 130 (14.7%) was most frequently detected in SARI cases followed by rhinovirus 121 (13.7%), respiratory syncytial virus 37 (4.2%) and enterovirus 36 (4.0%) respectively. The rate of human metapneumovirus 60 (15.7%) co-infection was high than rhinovirus 51 (13.4%), respiratory syncytial virus 13 (3.4%) and enterovirus 12 (3.1%) infection in elderly patients. Co-infection of human metapneumovirus, respiratory syncytial virus, and enterovirus were detected with influenza. Respiratory viruses were detected year-round in Nepal. Incidence of human metapneumovirus virus infection was most commonly detected in summer (July–Aug) and winter (Jan–Feb) season. Conclusion: Respiratory viruses are significantly higher in elderly patient with severe acute respiratory infection. Our findings highlight the importance of real time diagnostic facility for clinical management and minimize the use of antimicrobial agents for respiratory infections in Nepal.

Impacto de la pandemia COVID-19 en la mortalidad del paciente anciano con fractura de cadera

COVID-19 became a threat to the public health system, compromising the health of the population. Patients with hip fractures, due to their age and comorbidity, were high-risk patients in this pandemic. The purpose of this study was to observe how the pandemic affected the management of hip fractures in elderly patients. MethodsThis is a descriptive, retrospective study of all patients over the age of 65 diagnosed with a hip fracture that came to the emergency room of Vall d’Hebron University Hospital in the COVID-19 pandemic period, from the 11th of March to the 24th of April 2020. They were followed up during their hospital stay and 30 days after the fracture. ResultsA total of 63 patients were included, 18 (28.6%) of whom had a positive RT-qPCR for COVID-19. Four could not be operated on due to the severity of the disease they presented with upon admission, dying a few days afterwards. Three of these patients had COVID-19. The 83.3% of the patients with positive RT-qPCR presented respiratory symptoms during their hospitalization. The length of hospital stays of patients with a positive RT-qPCR (18.25±8.99 days) was longer than that of patients that were RT-qPCR negative (10.9±4.52 days) (P=.01). In-hospital mortality in operated patients was 20% in patients with a positive RT-qPCR, compared with 2.3% in the group of patients who tested negative (P=.018). Mortality at 30 days was 40% in the group with positive RT-qPCR vs 6.8% in patients not infected by SARS-CoV-2 (P=.002). ConclusionSARS-CoV-2 infection in elderly patients with hip fractures increases both the length of hospital stay, as well as in-hospital and 30-day mortality.

Opportunistic Infection in Hospitalised Patients with Inflammatory Bowel Disease.

To investigate the incidence, clinical features, and risk factors of opportunistic infections in elderly patients with inflammatory bowel disease (IBD). Observational study. Department of Digestive and Geriatrics Center, Sichuan University West China Hospital, China between January 2012 and January 2019. Patients (≥18 years) with IBD were enrolled in this study. Clinical data from the infected elderly group (age ≥60 years), non-infected elderly group (age ≥60 years) and infected adult group (age: 18-59 years) were compared. Logistic regression analysis was used for risk factors associated with opportunistic infection. A total of 8.9% (307/3,456) of patients with IBD had opportunistic infection. The opportunistic infection rate of elderly group was 16.5% (80/485), which was significantly higher than that of adult group (7.6%, 227/2,971, p <0.05). Compared with infected adult group or non-infected elderly group, infected elderly group had less fever and leukocytosis, but more hypoproteinemia and several activities (p <0.05). Cytomegalovirus and Epstein-Barr virus were the most common agents in elderly group and adult group, respectively. Multiple episodes (three or more) were more common in infected elderly group; the time of opportunistic infections was associated with systemic inflammatory reaction syndrome (SIRS, p <0.05). Logistic regression analysis showed that age ≥60 years, corticosteroids, immunosuppressive and biological agents were risk factors for opportunistic infections in patients with IBD. Hospitalised elderly IBD patients, receiving corticosteroids, immunosuppressive, and biological agents, are at higher risk for infection. The symptoms of opportunistic infections in elderly patients are atypical, but they are prone to multiple infections with poor prognosis. Key Words: Elderly patients, Inflammatory bowel disease, Opportunistic infection, Systemic inflammation reaction syndrome.

HIV/AIDS in the elderly: epidemiological impact and associated risk factors in the State of Piauí, Brazil

The objective of the present study was to determine the prevalence, epidemiological and socioeconomic profile and risk factors associated with HIV-1 infection in elderly patients diagnosed with HIV/AIDS in the state of Piauí, Brazil. A total of 805 individuals seen at the Central Laboratory of Public Health of Piauí were included. The subjects were classified into two groups: a group of individuals 18 to 59 years old and a group of those 60 years or older. These individuals were tested for HIV-1 infection (ELISA), which was monitored by TCD4+/CD8+ lymphocyte count (flow cytometry) and viral load quantification (branched DNA method), and for coinfections with HBV, HCV and HTLV-1/2 (ELISA and PCR). They also answered an epidemiological questionnaire on socio-demographic, epidemiological and clinical characteristics. The frequency of HIV-1 infection in elderly patients was 3.7% (30/805). The majority of patients were male (66.6%), had a primary school education level (90%), were married (40%) and had a family income of 1 to 4 times the minimum wage (63.3%). The main behavioral risk factors associated with these individuals included lack of condom use (100%) and a history of Sexual Transmitted Diseases – STI (53.3%), surgery (63.3%) or blood transfusion (40%). The elderly patients also had a higher frequency of HIV-HTLV-1/2 co-infection (13.3%). Identifying the main characteristics related to HIV infection in the elderly is important to show that these individuals are also susceptible to HIV-1 infection and must be made aware of risk behaviors.

Rabeprazole-amoxicillin dual therapy as first-line treatment for H pylori eradication in special patients: A retrospective, real-life study.

BackgroundThe currently recommended quadruple regimens for Helicobacter pylori infection might not be appropriate for every patient, especially in elderly patients or those with multiple comorbidities.ObjectiveTo evaluate the efficacy and safety of rabeprazole‐amoxicillin dual therapy in H pylori‐positive elderly patients or those with multiple comorbidities.MethodsFrom November 2013 to May 2017, the clinical data of H pylori‐positive patients ≥60 years old or with multiple comorbidities were collected and reviewed. All patients were given rabeprazole 10 mg three times a day and amoxicillin 1000 mg thrice a day (RA dual therapy) for 14 days as first‐line treatment. H pylori eradication was evaluated by 13C‐urea breath test 6 weeks after treatment. Adverse effects were recorded.ResultsA total of 198 patients were enrolled, including 116 elderly patients and 82 patients with multiple comorbidities. Successful eradication was achieved in 90.9% (180/198, 95% CI: 86.1%‐94.2%) patients. Adverse effects, which were mainly mild (referring to skin rash, abdominal pain, and diarrhea), occurred in 22 patients (22/198, 11.1%) and resolved spontaneously.ConclusionDual therapy composed of rabeprazole and amoxicillin as a first‐line treatment appears to be effective and safe for H pylori infection in elderly patients or those with multiple comorbidities. Additional studies are needed to optimize the regimen.

INFEKSI JAMUR PADA GERIATRI

&lt;p&gt;&lt;em&gt;Elderly patients need special and thorough attention, because in elderly patients often occur more than one disease multipatologi. One of them is an infectious disease that is prone to occur in elderly patients due to decreased functional body reserve, decreased immunity, repeated hospital stays, diagnosis and therapy that is often late, decreased response to antibiotic therapy, and increased potential for side effects and interactions between drug. Fungal infections are an increasing problem in the elderly population including opportunistic fungal infections in elderly patients with immunocompromised conditions with multipatolgi disease and coincidence, post chemotherapy in malignancies, post-transplantation, or receive immunosuppressant therapy due to dermatological and rheumatological diseases.&lt;/em&gt;&lt;strong&gt;&lt;em&gt;&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;

Factors associated with infection of primary total knee prosthesis in older adults in a referral hospital in Peru. 2012–2015

ObjectiveTo determine the risk factors associated with prosthetic knee infection in elderly patients in a referral hospital in Peru. Patients and methodsA case and control study was performed. The calculated sample was 44 cases and 132 controls. The data were collected retrospectively from clinical records. U-Mann–Whitney and Chi-square tests were performed in the comparison of cases and controls. Odds ratios (OR) were calculated in a binary logistic regression analysis to identify the risk factors, a p<.05 and a 95% confidence interval (CI) were considered significant. ResultsSignificant (p<.05) risk factors evidenced in the bivariate analysis were obesity (OR=9.72; 95% CI: 4.47–21.14), smoking (OR=4.06; 95% CI: 1.59–10.39), rheumatoid arthritis (OR=4.66; 95% CI: 1.52–14.32), diabetes mellitus type2 (OR=5.63; 95% CI: 2.69–11.78), persistent drainage (OR=9.27; 95% CI: 3.85–22.31), superficial infection (OR=6.87; 95% CI: 3.25–14.49) and prolonged hospital stay (OR=4.67; 95% CI: 2.26–9.64). In the multivariate analysis where it was adjusted for confounding variables, it was determined that risk factors were obesity (ORa=9.14; 95% CI: 3.28–25.48), diabetes mellitus (ORa=3.77; 95% CI: 1.38–10.32), persistent drainage (ORa=4.64; 95% CI: 1.03–20.80) and superficial wound infection (ORa=27.35; 95% CI: 2.57–290.64). ConclusionsRisk factors for prosthetic knee infection identified in this study are preventable. The main risk factors were obesity, diabetes mellitus type 2, superficial wound infection and persistent drainage, which were considered together or separately to be risk factors in the population studied.

Clinical efficacy and safety of silver nanoparticlebased disinfectant combined with piperacillin sodium and sulbactam sodium in the treatment of lower respiratory tract infection

This study evaluated the clinical efficacy and safety of piperacillin sulbactam in the treatment of lower respiratory tract infections, as well as the efficacy of silver nanoparticle-based disinfectant in equipment disinfection to reduce exogenous infection. From May 2018 to November 2018, 100 patients that had been diagnosed with a lower respiratory tract infection and hospitalized were divided into an experimental group and a control group. The experimental group was given piperacillin/sulbactam, and the control group was given mezlocillin/sulbactam, where 5.0 g was added to 100 mL of normal saline and administered via intravenous drip twice a day over a treatment course of 14 days. The cure rate of the experimental and control groups were 65.22% and 56.52% respectively. The efficacy rate was 91.30% and 91.30% respectively, with no significant difference between the two groups (P &gt; 0.05). The results indicated that piperacillin/sulbactam is a safe, effective treatment for lower respiratory tract infections in elderly patients, the equipment was sterilized with silver nanoparticle-based disinfectant to reduce the incidence of adverse reactions and exogenous infections.

Defective Granuloma Formation in Elderly Infected Patients.

Granulomas are compact structures formed in tissues by the immune system in response to aggressions. The in vitro formation of granulomas using circulating mononuclear cells is an innovative method to easily assess the immune response of patients. Monitoring the efficiency of mononuclear cells from patients to form granulomas in vitro would help improve their therapeutic management. Circulating mononuclear cells from 23 elderly patients with sepsis and 24 elderly controls patients were incubated with Sepharose beads coated with either BCG or Coxiella burnetii extracts. The formation of granulomas was measured over 9 days. Most healthy elderly patients (92%) were able to form granulomas in response to BCG and Coxiella burnetii extracts compared to only 48% of infected elderly patients. Undernutrition was significantly associated with impaired granuloma formation in healthy and infected patients. Granulomas typically comprise epithelioid cells and multinucleated giant cells, however, these cells were not detected in samples obtained from patients unable to form granulomas. We also found that the impairment of granuloma formation was associated with reduced production of tumor necrosis factor without overproduction of interleukin-10. Finally, all genes specifically modulated in granulomatous cells were down-modulated in patients with defective granuloma formation. TNFSF10 was the only M1 gene markedly upregulated in patients who did not form granulomas. Our study suggest that defective granuloma formation may be a measurement of altered activation of immune cells which can predispose to nosocomial infections in elderly patients.

Clinical effect of nebulized acetylcysteine inhalation combined with bronchoscopy in the treatment of elderly patients with severe ventilator-associated pneumonia

Objective: To explore the clinical effect of nebulized acetylcysteine inhalation combined with bronchoscopy in treating elderly patients with severe ventilator-associated pneumonia (VAP). Methods: From January 2016 to December 2017, 80 elderly patients with severe VAP who were hospitalized in Zhejiang Hospital were divided into acetylcysteine+ bronchoscopy group [24 males and 16 females, aged (78±7) years] and bronchoscopy group [26 males and 14 females, aged (80±7) years]using random number table for a prospective cohort study. Patients in bronchoscopy group were treated with bronchoscopy in addition to conventional supportive care of symptoms. Patients in acetylcysteine+ bronchoscopy group received nebulized acetylcysteine inhalation therapy on the basis of the treatment given to patients in bronchoscopy group. Patients in both groups received treatment continuously for 7 days. The simplified clinical pulmonary infection score (CPIS) in both groups was assessed before and after treatment. Venous blood of 10 mL was collected before and after treatment to detect leukocyte count, serum C-reactive protein, and procalcitonin. Arterial blood of 1 mL was collected before and after treatment to detect partial arterial oxygen pressure (PaO(2)), partial arterial carbon dioxide pressure (PaCO(2)), oxygenation index. The inhalation platform pressure (Pplat), dynamic lung compliance (Cdyn), airway resistance, work of breathing, time of antibiotic use, and time of mechanical ventilation of patients in two groups were recorded before and after treatment. Data were statistically analyzed with chi-square test and t test. Results: (1) The simplified CPIS, leukocyte count, serum C-reactive protein, and procalcitonin of patients in acetylcysteine+ bronchoscopy group were significantly lower than those in bronchoscopy group after treatment (t=2.32, 2.15, 6.08, 7.12, P<0.05 or P<0.01). The simplified CPIS, leukocyte count, serum C-reactive protein, and procalcitonin of patients in acetylcysteine+ bronchoscopy group and bronchoscopy group after treatment were significantly lower than those before treatment (t=13.76, 13.60, 12.70, 8.32, 11.44, 14.28, 9.48, 9.50, P<0.01). (2) Compared with bronchoscopy group, patients in acetylcysteine+ bronchoscopy group had significantly higher PaO(2) and oxygenation index (t=4.14, 2.55, P<0.05 or P<0.01) but significantly lower PaCO(2) (t=4.36, P<0.01) after treatment. The PaO(2) and oxygenation index of patients in acetylcysteine+ bronchoscopy group after treatment were significantly higher than those before treatment (t=10.90, 43.72, P<0.01). The PaO(2) and oxygenation index of patients in bronchoscopy group after treatment were also significantly higher than those before treatment (t=6.55, 43.03, P<0.01). The PaCO(2) of patients in both groups after treatment were significantly lower than those before treatment (t=21.54, 21.92, P<0.01). (3) The Cdyn of patients in acetylcysteine+ bronchoscopy group after treatment was significantly higher than that in bronchoscopy group (t=5.41, P<0.01), and Pplat, airway resistance, and work of breathing were significantly lower than those in bronchoscopy group (t=2.18, 5.46, 2.49, P<0.05 or P<0.01). The Cdyn of patients in both groups after treatment were significantly higher than those before treatment (t=16.10, 10.90, P<0.01), and Pplat, airway resistance, and work of breathing were significantly lower than those before treatment (t=21.18, 11.13, 9.32, 15.50, 5.17, 5.97, P<0.01). (4)The time of mechanical ventilation and antibiotic usage of patients in acetylcysteine+ bronchoscopy group were (6.9±1.9)and (8.7±2.8) d, respectively, which were significantly shorter than (10.1±2.2) and (11.6±3.5) d in bronchoscopy group (t=6.85, 4.09, P<0.01). Conclusions: Nebulized acetylcysteine inhalation combined with bronchoscopy can significantly control the degree of lung infection in elderly patients with severe VAP, improve patients' respiratory mechanics parameter and blood gas analysis indicator, and shorten the time for mechanical ventilation and antibiotic usage.

Ações de enfermagem frente à prevenção de infecções relacionadas à assistência à saúde em idosos

A infecção hospitalar (IH) é um problema de saúde, aonde aproximadamente 10% dos pacientes no mundo apresentam após internação, sendo que desses, 15 a 50% dos pacientes evoluem para o óbito. Considerando o enfermeiro como agente relevante da prevenção, a pesquisa objetiva demonstrar os meios de prevenção e cuidados prestados pelo enfermeiro para evitar o surgimento de Infecções Relacionadas à Assistência à Saúde em pacientes idosos utilizando a revisão integrativa de artigos, monografias ou livros de 2014 a 2018 para responder a questão norteadora: “quais os meios de prevenção que o enfermeiro utiliza para clientes idosos com risco para IH no âmbito assistencial de saúde?”. Utilizou-se como método a revisão integrativa bibliográfica nas bases de dados LILACS e BDENF e através da biblioteca virtual SCIELO, utilizando-se dos Descritores de Ciências da Saúde: “enfermagem, prevenção, infecção hospitalar, cuidados de enfermagem, infecção, idosos, sondas” adicionando o booleano “and” na pesquisa de cada base. O resultado desse estudo permitiu localizar 460 artigos relacionados ao tema onde apenas 26 artigos foram colhidos e lidos na íntegra, sendo que seis artigos foram excluídos por não atenderem aos critérios. A partir dos 20 artigos formularam-se sete respostas que foram discutidos e divididos em dois blocos “procedimentos gerais para prevenção de IH” e “procedimentos específicos para prevenção de IH”. O trabalho concluiu considerar o enfermeiro como profissional insubstituível na equipe multidisciplinar de saúde diante dos meios de prevenção que se utiliza, através de medidas gerais e específicas de prevenção.

Epidemiological and clinical characteristics of healthcare-associated infection in elderly patients in a large Chinese tertiary hospital: a 3-year surveillance study

BackgroundWe analyzed the results of a 3-year surveillance study on the epidemiological and clinical characteristics of healthcare associated-infections (HAIs) in elderly inpatients in a large tertiary hospital in China.MethodsReal-time surveillance was performed from January 1, 2015 to December 31, 2017. All HAIs were identified by infection control practitioners and doctors. Inpatient data were collected with an automatic surveillance system.ResultsA total of 134,637 inpatients including 60,332 (44.8%) elderly ≥60 years were included. The overall incidence of HAI was 2.0%. The incidence of HAI in elderly patients was significantly higher than that in non-elderly patients (2.6% vs. 1.5%, χ2 = 202.421, P < 0.01) and increased with age. The top five sites of HAIs in the elderly were the lower respiratory tract, urinary tract, blood stream, antibiotic-associated diarrhea, and surgical site. The five most common pathogens detected in elderly HAI patients were Candida albicans, Klebsiella pneumonia, Acinetobacter baumannii, Escherichia coli, and Pseudomonas aeruginosa. The incidence of ventilator-associated pneumonia in the elderly was lower than in the non-elderly, catheter-associated urinary tract infections were more common in elderly patients, and the rate of central line-associated bloodstream infection was similar between groups. The numbers of male patients and patients with comorbidities and special medical procedures (e.g., intensive care unit admission, cerebrovascular disease, brain neoplasms, hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease, malignant tumor, malignant hematonosis, and osteoarthropathy) were significantly higher in the elderly group, but the number of patients who underwent surgery was lower.ConclusionWe observed a significantly higher overall incidence of HAI in elderly inpatients ≥60 compared to non-elderly inpatients < 60 years, but the trend was different for device-associated HAIs, which was attributed to the higher rates of comorbidities and special medical procedures in the elderly group. The main HAI sites in elderly inpatients were the lower respiratory tract, urinary tract, and bloodstream, and the main pathogens were gram-negative bacilli and Candida albicans.

Initial high-dose corticosteroids and renal impairment are risk factors for early severe infections in elderly patients with antineutrophil cytoplasmic autoantibody-associated vasculitis

Recent large observational studies of antineutrophil cytoplasmic autoantibody-associated vasculitis (AAV) show that severe infection is a major cause of death and that the majority of infections occur during the early phase of initiating remission-induction therapy. Many risk factors for severe infection have been suggested, but these have been inconsistent. Nevertheless, infectious risk factors in elderly patients with AAV have not been adequately investigated in previous studies.In this retrospective observational study, we examined potential predictors of severe infection within 90 days (early severe infections) after remission-induction therapy in patients with AAV aged 65 years or older. We included 167 consecutive elderly patients with AAV admitted to our hospital. Data from medical history and remission-induction therapy were analyzed for predictive risk factors associated with early severe infections. The relationship between initial doses of corticosteroids and cumulative incidence of severe infections was also analyzed. A multivariate analysis of risk factors for early severe infections was performed using logistic regression analysis. The Kaplan-Meier method was used to estimate the overall survival, and the log-rank test was used to evaluate the differences between patients with and without early severe infections. Gray method was used to compare the cumulative incidence of severe infections in patients who did and did not receive initial high-dose corticosteroids.Logistic regression analysis showed that initial high-dose corticosteroid administration (prednisolone ≥0.8 mg/kg/d) (odds ratio [OR] 3.86, P = .030) and serum creatinine levels at diagnosis ≥1.5 mg/dL (OR 5.13, P = .003) were independent predictors of early severe infection although administration of cyclophosphamide or rituximab was not. The cumulative incidence of severe infections was also significantly higher in patients who received initial high-dose corticosteroids (P = .042), and patients with early severe infections exhibited a high mortality rate within 6 months (P < .001).Our findings suggest that initial high-dose corticosteroids and renal impairment at diagnosis are associated with a higher risk of early severe infections and early death in elderly patients with AAV.

Factores asociados a infección de prótesis total de rodilla primaria en adultos mayores en un hospital de referencia en Perú. 2012-2015

ObjectiveTo determine the risk factors associated with prosthetic knee infection in elderly patients in a referral hospital in Peru. Patients and methodsA case and control study was performed. The calculated sample was 44 cases and 132 controls. The data were collected retrospectively from clinical records. U-Mann Whitney and Chi-square tests were performed in the comparison of cases and controls. Odds ratios (OR) were calculated in a binary logistic regression analysis to identify the risk factors, a P<.05 and a 95% confidence interval (CI) were considered significant. ResultsSignificant (P<.05) risk factors evidenced in the bivariate analysis were obesity (OR=9.72; 95%CI: 4.47-21.14), smoking (OR=4.06; 95%CI: 1.59-10.39), rheumatoid arthritis (OR=4.66; 95%CI: 1.52-14.32), diabetes mellitus type2 (OR=5.63; 95%CI: 2.69-11.78), persistent drainage (OR=9.27; 95%CI: 3.85-22.31), superficial infection (OR=6.87; 95%CI: 3.25-14.49) and prolonged hospital stay (OR=4.67; 95%CI: 2.26-9.64). In the multivariate analysis where it was adjusted for confounding variables, it was determined that risk factors were obesity (ORa=9.14; 95%CI: 3.28-25.48), diabetes mellitus (ORa=3.77; 95%CI: 1.38-10.32), persistent drainage (ORa=4.64; 95%CI: 1.03-20.80) and superficial wound infection (ORa=27.35; 95%CI: 2.57-290.64). ConclusionsRisk factors for prosthetic knee infection identified in this study are preventable. The main risk factors were obesity, diabetes mellitus type2, superficial wound infection and persistent drainage, which were considered together or separately to be risk factors in the population studied.

Eczema with secondary infection in elderly patients in the outpatient practice of a dermatovenerologist

Eczema with secondary infection in elderly patients in the outpatient practice of a dermatovenerologist

Periprosthetic infection in elderly patients treated with hemiarthroplasty of the hip following intracapsular fracture. Should be use antibiotic-loaded bone cement?

IntroductionProsthetic infections are a potentially devastating complication, especially in elderly patients. Antibiotic-loaded bone cement has been used both as a treatment and prophylaxis in prosthetic infection, and its use is not well documented in the prophylaxis of infection in patients who have suffered a hip fracture. MaterialA retrospective descriptive was performed. The data were obtained from all the patients who underwent hip hemiarthroplasty due to a subcapital fracture between 2011 and 2017 (N=241). An epidemiological study of the patients studied was carried out. We analysed the incidence of periprosthetic infection in the groups treated with cement without antibiotic and antibiotic-loaded bone cement, as well as the protective effect of the antibiotic-loaded bone cement. At the same time, a pilot cost analysis study was carried out. ResultsIn the group that received antibiotic-loaded bone cement (n=94) there were 8 infections (8%), while in the group with cement without antibiotic (n=147) there were 28 infections (19%). The odds ratio (OR) was calculated, showing a 55.3% reduction in the risk of developing late infection in the group that received cement with antibiotic (95% CI: 6.2–78.7 %) (P=.0025). The use of antibiotic-loaded bone cement led to significant cost savings per patient. ConclusionsThe use of antibiotic-loaded bone cement is a protective factor in the development of late infection after hip hemiarthroplasty surgery in elderly patients with hip fracture.

Pneumonia prevention in the elderly patients: the other sides.

Pneumonia is one of the leading causes of morbidity and mortality from infection in elderly patients. The increased frequency of pneumonia among elderly subjects can be explained by the physiological changes linked to the progressive aging of the respiratory tree and the diminished immunological response. A spiral of event leads to frailty, infection and possible death; preventing pneumonia consists of controlling the risk factors. Dysphagia, which is associated with malnutrition and dehydration, is recognized as one of the major pathophysiological mechanism leading to pneumonia and its screening is crucial for the pneumonia risk assessment. The impairment in the oropharyngeal reflexes results in stagnation of foreign material in the lateral cavities of the pharynx which may then get aspirated repeatedly in the lungs and cause pneumonia. Pneumonia prevention starts with lifestyle modifications such as alcohol and tobacco cessation. A careful review of the risk-benefit of the prescribed medication is critical and adaptation may be required in elders with multiple morbidities. Respiratory physiotherapy and mobilization improve the functional status and hence may help reduce the risk of pneumonia. Maintaining teeth and masticatory efficiency is important if malnutrition and its consequences are to be avoided. Daily oral hygiene and regular professional removal of oral biofilm can prevent the onset of periodontitis and can avoid an oral environment favoring the colonization of respiratory pathogens than can then be aspirated into the lungs.

Which antibiotics should we prefer empirical treatment of urinary tract infections in elderly patients?

Aim: Urinary tract infection (UTI) is a major cause of mortality and morbidity in elderly patients. In this cross-sectional study, we aimed to determine the frequency and antibiotic resistance profile of the bacteria causing UTI and contribute to the empirical treatment options in elderly patients.Methods: This study included urine culture results from 347 elderly outpatients who were referred to Karabuk Training and Research Hospital between January 2018 and June 2019. The identification and antibiotic susceptibilities of microorganisms were determined using the BD-Phoenix 100 fully automated system, and the extended-spectrum beta-lactamase (ESBL) positivity was analyzed using the combined disk diffusion method. The results were retrospectively analyzed. Results: The most common pathogens were Escherichia coli (58%), Enterococcus spp. (18%) and Klebsiella pneumoniae (11%). The rate of resistance to ampicillin, amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole (TMP-SMX), cefixime, and ciprofloxacin, which are oral antibiotics used in the treatment of UTI, was between 30% and 70%. The rate of resistance to nitrofurantoin was 3%. The gentamicin and piperacillin-tazobactam resistance were 12% and 9%, respectively. The ESBL positivity for E. coli and K. pneumoniae were 29% and 49%, respectively (P=0.03).Conclusion: The rates of resistance to oral antibiotics such as ampicillin, amoxicillin-clavulanic acid, TMP-SMX, cefixime, and ciprofloxacin, which are used treatment of UTI, were more than 20%. Therefore, these antibiotics should not be used in the empirical treatment of UTI. Instead, nitrofurantoin may be preferred in the empirical treatment of uncomplicated UTI, or gentamicin and piperacillin-tazobactam, which are parenteral antibiotics that may be used depending on the patient’s clinical condition.

Effect of lung protective ventilation on perioperative pulmonary infection in elderly patients with mild to moderate COPD under general anesthesia

ObjectiveThe research aims to explore the effects of different ventilation time on postoperative pulmonary infection in elderly patients with the mild and moderate chronic pulmonary obstructive disease (COPD), so as to provide evidence for reducing postoperative pulmonary infection complications in patients with COPD. Methods120 elderly patients with mild and moderate COPD were selected as the research objects. First, the general information of patients with COPD before surgery and the difference between healthy population and lung forced expiratory volume in 1s (FEV1), forced vital capacity (FVC), FEV1/FVC and maximum midexpiratory flow (MMEF) functional indexes were analyzed and detected. Patients with COPD were operated on with single lung ventilation and general anesthesia. Patients with mild and moderate COPD were divided into two groups according to lung ventilation time (ventilation time 1.0–2.0h group, ventilation time >2.0h group). The inflammatory factors of IL-6, IL-21, TNF-α, and CXCL13 as well as inflammatory indicators of polycaprolactam (PCT), C-reactive protein (CRP) and white blood cell (WBC) in serum of all patients were detected after the operation. The probability of pulmonary infection after COPD was diagnosed and analyzed. Finally, the regression analysis of postoperative pulmonary infection in COPD patients was analyzed. Results(1) The results showed that the smoking rate of mild and COPD patients was significantly higher than that of healthy people (P<0.05). (2) The lung function indexes of the mild and moderate groups were significantly lower than those of the control group (P<0.01), while the lung function indexes of the moderate group were significantly lower than those of the mild group (P<0.05). (3) All the inflammatory indicators of moderate COPD patients were significantly higher than those of mild COPD patients (P<0.05). (4) All inflammation-related indicators in patients with mild and moderate COPD with ventilation time of >2.0h were significantly higher than those in the 1.0–2.0h group (P<0.05). (5) The probability of postoperative pulmonary infection in moderate patients was significantly higher than that in mild patients (P<0.01). The probability of postoperative pulmonary infection in >2.0h group was significantly higher than that in the 1.0–2.0h group (P<0.01). (6) Multivariate Logistic regression analysis results showed that lung function, duration of lung ventilation and smoking were independent risk factors for postoperative pulmonary infection in COPD patients. ConclusionIt is important to detect pulmonary function before surgery, maintain single lung ventilation protection for no more than 2.0h during surgery, and quit smoking to improve pulmonary infection in patients with COPD after surgery. In addition, the incidence of postoperative pulmonary infection in patients with moderate COPD was higher than that in patients with mild COPD, suggesting that early treatment in patients with COPD was also of great significance in reducing the incidence of postoperative pulmonary infection.