Infections In Elderly Population Research Articles

P116 Cutaneous fungal infections in elderly population from Bhopal

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM ObjectivesTo know the distribution of fungal infections based on various demographic characteristics.To study the clinical presentation of the lesions and their distribution.To isolate and identify the fungal pathogens.MethodsHospital-based cross-sectional study for 5-year duration January 2017-December 2021. Study location is the department of Microbiology AIIMS, Bhopal. Elderly patients (60 years and above) visiting as Outpatient and Inpatient of dermatology and venereology, General Medicine, and other departments with cutaneous infections suspected to be of fungal etiology and fulfilling the inclusion criteria comprised the study population. Patients already on antifungals topical or systemic were excluded. Data extraction was based on predesigned proforma for a detailed history and clinical examination entries. Necessary ethical approval and patient consent were obtained. Samples of skin, hair, nail, and exudates were processed for direct microscopy, culture isolation in suitable media, and identification phenotypically.ResultsA total of 480 elderly patients clinically suspected of cutaneous fungal infections were included in the study. Majority of the suspected cases were in 60–70 years age group 360/480 (75%). Males were 349/480 (72.71%) and females were 131/480 (27.29%) of the total suspected cases. Male to female ratio in study population was 2.66: 1. Tinea corporis 140/480 cases (29.17%) was most common clinical type followed by onychomycosis 64/480 cases (13.33%), ulcerations 62/480 (12.92%), T. cruris 56/480 (11.67%), T. pedis 35/480 (7.29%), T. mannum 25/480 (5.21%), and T. facei 12/480 (2.50%) in suspected cases of cutaneous fungal infection. Majority of cases were found in non-dependent 253/480 (52.70%) population. Out of 480 clinically suspected cases of cutaneous fungal infection was demonstrated in 193 cases (40.20%) either by direct microscopy and/or culture.A total of 176/480 cases (36.67%) were KOH positive and 113(23.54%) cases were culture positive.Taking culture as a gold standard sensitivity and specificity of KOH in diagnosing fungal infection was 84.96% and 78.2% respectively. Among 113 culture isolates dermatophytes 53.10% (60/113) were most common mold isolates followed by non-dermatophyte molds 28.3% (32/113), and yeasts 18.59% (21/113). Trichophyton mentagrophytes most common 21.24% followed by T. tonsurans 9.73%, and T. violaceum 7.96% are the common dermatophyte isolates. Aspergillus species is the most common non-dermatophyte mold isolated.Diabetes was the most common comorbid condition in culture-confirmed cases followed by hypertension and thyroid disorder.ConclusionThis study showed the prevalence of cutaneous fungal infection among elderly visiting AIIMS, Bhopal as 23.54% (113/480). With increase in elderly population, changing environmental conditions, and association with non-communicable diseases it becomes important that all elderly patients visiting hospital OPD and those hospitalized for long should be evaluated for fungal infections especially cutaneous.

Virulence and DNA sequence analysis of Cronobacter spp. isolated from infant cereals

Cronobacter spp. is an opportunistic pathogen that causes severe infections, affecting newborns and infants, and is also an emerging cause of hospital-acquired infection in elderly populations. These infections are mainly associated with the consumption of infant formulas, even though these bacteria have been isolated from other foods as well. Cronobacter spp. invades epithelial cells and escapes the immune response mechanisms, multiplying inside macrophages. However, the pathogenesis and virulence factors of these bacteria have not been fully elucidated and need to be further studied. Therefore, this study aimed to evaluate the ability of Cronobacter spp. strains isolated from infant cereals to invade and survive within macrophages, investigate the virulence phenotype using the Galleria mellonella model, and identify possible genes involved in bacterial pathogenesis through pan-genome analysis. All the isolates were able to invade macrophages and the survival of bacteria decreased over a 72 h period, with bacterial cell counts reaching up to 106 CFU/ml. Cronobacter sakazakii isolate 112 exhibited a similar mortality rate (40–70%) to the ATCC BAA 894 strain (Cronobacter sakazakii) in G. mellonella assay. In addition, some unique virulence genes (isolate 7, ada_2, tcmA_1, acrB_3; isolate 78, ampC_2, rihC_1 and isolate 112, fimH, ylpA, gtrA) were identified within isolates with the invasive profile in the in vivo and in vitro assays. Furthermore, isolates from different species were grouped into seven distinct clusters in the pan-genome analysis. The most virulent isolates (7, 78, and 112) were grouped in distinct subclusters in the cladogram. This work revealed potential Cronobacter spp. pathogenic strains recovered from infant cereals.

Serotype Distribution, Antimicrobial Susceptibility, and Multilocus Sequencing Type (MLST) of Streptococcus pneumoniae From Adults of Three Hospitals in Shanghai, China.

Background: Streptococcus pneumoniae, a main causative agent associated with invasive and non-invasive infection in elderly population, is a major global health problem. After pneumococcal conjugate vaccines (PCV) and pneumococcal polysaccharide vaccines (PPV) were introduced, the distribution of S. pneumoniae serotypes has changed. There was currently limited data on epidemiology and status of antimicrobial resistance of S. pneumoniae in Shanghai.Objective: To determine the serotype distribution, antimicrobial susceptibility and molecular epidemiology of S. pneumoniae isolated from adults in Shanghai.Method: A total of 75 S. pneumoniae isolates consecutively collected from 2015 through 2017 were serotyped by conventional multiplex-PCR. The antimicrobial susceptibility was determined by broth microdilution method. The multilocus sequence type (MLST) was performed to estimate the molecular epidemiology.Results: The predominant serotypes among the isolates were 19F (20.00%), 3 (16.00%), 23F (9.33%), 14 (8.00%), and19A (5.33%). The prevalence of pneumococcal strains with serotypes targeted by vaccines PCV7, PCV10, PCV13, and PPV23 was 44, 45.33, 66.67, and 80%, respectively. Penicillin non-susceptible S. pneumoniae (PNSSP) accounted for 16% of the isolates examined and resistance to erythromycin, azithromycin, tetracycline, clindamycin, cefaclor and trimethoprim-sulfamethoxazole were found in 92.00, 90.67, 86.67, 81.33, 54.67, and 54.67% of isolates, with most isolates (78.67%) presenting multidrug-resistance. The top three sequence types (STs) were ST271 (17.33%), ST180 (9.33%), and ST81 (8.00%). The international resistance clone complexes Spain23F-1 (n = 4), Netherland3-31 (n = 8), and Taiwan19F-14 (n = 14) were identified.Conclusions: The S. pneumoniae isolates showed high genetic diversity in Shanghai and the prevalence of antimicrobial resistance was also high among S. pneumoniae isolates, most of which were multidrug-resistant. The spread of international resistance clones might contribute to the increase of resistant isolates. The PPV23 could protect against most pneumococcal capsular serotypes causing infection of adults in Shanghai.

2147. Human Infections due to Actinotignum Species: A 5-Year Retrospective Review at Mayo Clinic Rochester, Minnesota

BackgroundWe aim to investigate the incidence, clinical presentation, management, and outcome of infections due to Actinotignum species observed at Mayo Clinic Rochester over the last 5 years.MethodsWe searched the clinical microbiology laboratory database to identify isolates of Actinotignum spp. from all body sites between January 1, 2014 and December 31, 2018.ResultsFifty-four patients with positive culture with Actinotignum were identified. Mean age was 67 years and 27 (50%) had an underlying urogenital condition. Actinotignum was isolated in 26 urine cultures, 6 blood cultures, 12 abscess fluid cultures, and 10 bone/joint tissue cultures (Table 1). Fifteen (28%) specimens were monomicrobial while 39 (72%) were polymicrobial. Recovery from urine cultures was interpreted as colonization in 11 (20%) cases. Of the 54 patients with positive cultures, 43 patients had Actinotignum-associated clinical infection; 15 (35%) with urinary tract infections (11 with cystitis and 4 with pyelonephritis), 12 (28%) with abscesses (skin, intraabdominal, and surgical site infections), 10 (23%) with bone/joint infection, and 6 (14%) with bacteremia (Table 2). Most frequently isolated species was A. schaalii (n = 40); followed by 2 cases of A. sanguinis. Susceptibility testing (n = 40) showed that all stains were susceptible to penicillin (MIC< = 0.5), 36% were susceptible to clindamycin (MIC < = 2) and 10% susceptible to metronidazole (MIC < = 8). There was no recurrence of Actinotignum-related infections in any of the treated cases. Two patients with bone/joint infection underwent repeat surgical intervention due to worsening infection while on antibiotic treatment prior to resolution of infection. There was 1 death in a patient with bacteremia (polymicrobial) who had presented with a massive stroke (Table 3).Conclusion A. schaalii was most commonly associated with urinary tract infections followed by abscesses and bone/joint infections in elderly population. Majority of the infections were polymicrobial. All tested isolated were susceptible to penicillin; however, resistance was frequent for clindamycin and metronidazole. All appropriately treated patients had resolution of infection without recurrence from Actinotignum, except for one patient with bacteremia who died from massive stroke Disclosures All authors: No reported disclosures.

Prevention of traditional Chinese medicine Gubiao Pixie prescription for nosocomial infection in elderly population

To observe the curative effect of traditional Chinese medicine (TCM) Gubiao Pixie prescription on the prevention of nosocomial infection in elderly patients with susceptible factors. A prospective observational study was conducted. The elderly patients aged over 70 years admitted to the Department of Integrated TCM and Western Medicine of Tianjin First Center Hospital from March 2015 to March 2016 were enrolled. The patients were divided into experiment group and control group by random number table. The patients in control group were given conventional treatment without special intervention; and those in experimental group were given Gubiao Pixie prescription particles (prescription composition: Radix Astragali 30 g, Bran fried Rhizoma Atracylodis 20 g, Raidix Saposhnikoviae 12 g, Radix Scutellariae 10 g, Fructus Tsaoko 6 g) on the basis of conventional treatment. The Gubiao Pixie prescription particles were taken in warm water 300 mL, twice a day in morning and evening respectively, taking half an hour after meals, and were increased or decreased according to the disease condition. The changes in immune function parameters before and after treatment, as well as the incidence of nosocomial infection, the abnormal increase rate of body temperature, white blood cell (WBC), and C-reactive protein (CRP) after 10 days of treatment in the two groups were observed. A total of 110 elderly patients with susceptible factors during hospitalization were included. After the exclusion of vomiting, abdominal distension and failure to conform the trial requirements, hospitalization time less than 10 days of patients, a total of 100 patients were enrolled in the analysis finally, with 50 patients in control group and in experimental group respectively. There were no significant differences in immune function parameters including IgA, IgG, IgM before treatment between the two groups. After 10 days of treatment, the immune function parameters showed no significant improvement in control group, and those in experiment group were improved significantly, and IgA (g/L: 1.59±0.32 vs. 1.29±0.29), IgG (g/L: 12.07±2.37 vs. 10.23±1.91), and IgM (g/L: 1.01±0.29 vs. 0.88±0.24) were significantly increased as compared with those of control group (all P < 0.01). Compared with the control group, the incidence of nosocomial infection (20% vs. 38%) and the abnormal increase rate of body temperature (24% vs. 44%), WBC (28% vs. 52%), and CRP (28% vs. 50%) 10 days after treatment in experimental group were significantly decreased (all P < 0.05). TCM Gubiao Pixie prescription has a role in enhancing immune function and antibacterial and bactericidal effect. It has certain preventive effect on nosocomial infection in susceptible people.

Hepatitis C Infection in the Elderly.

Hepatitis C virus (HCV) infection in the elderly population is a global medical burden and healthcare utilization concern. The majority of patients with hepatitis C in the USA are "baby boomers," who were born between 1945 and 1965. Consistently worldwide, HCV infection in elderly population is overrepresented and poses public health concerns. These individuals have been infected now for over two decades and are presenting with advanced liver disease. Traditionally, the use of pegylated interferon-based therapy has been limited in the elderly because of its adverse effects. The sustained virologic responses have also tended to be lower in the elderly than in younger adults. The emergence of non-interferon-based therapy with direct acting antiviral agents has expanded the pool of patients eligible for treatment. These agents have been found to be effective, tolerable, and safe in the elderly population.

Community acquired infections in elderly population

Abstract In geriatric practice, data regarding infections including the epidemiology, morbidity, and mortality are lacking. Our aim was to evaluate the frequency, location, microbiological and laboratory characteristics of infectious diseases in elderly population admitted to a training hospital. The patients were included total of 330 patients, aged over 65 with infection, seen between January 1, 2005 and January 1, 2006. In the result, of patients 136 (41%) had respiratory system infection, 90 (27%) urinary system infection, 39 (12%) gastrointestinal system infection, 34 (10%) bloodstream infections, 17 (5%) soft tissue infection, 8 (2%) central nervous system infections, and 6 (2%) others. Average length of hospitalization was 8.6±7.7 days. Mortality rate from all causes was 57 (17%). The most common infections in elderly patients were respiratory tract and urinary system infections, and there were no fever, leukocytes and high CRP levels in approximately 1/3 of cases. Infectious diseases may occur even in the absence of such infection indicators as fever, raised WBC count and high CRP level in the elderly population.

Urinary tract infection in geriatric and institutionalized patients.

The importance of urinary tract infection in elderly populations and some of the unique features in its evaluation and therapy are becoming better recognized. In elderly populations in the community there are concerns about increasing antimicrobial resistance in infecting organisms. In postmenopausal women, the importance of vaginal estrogen deficiency as a factor which promotes urinary tract infection is becoming increasingly recognized, leading to therapeutic strategies other than antimicrobials. For elderly residents of long term care facilities, urinary tract infection is very common, and most frequent in those with the greatest functional impairment. Whilst it is recognized that asymptomatic bacteriuria should not be treated, the diagnosis of urinary tract infection in this population often presents a dilemma. In particular, the urine culture is useful only in excluding urinary tract infection, not in making a diagnosis of symptomatic infection. There has been a tendency to manage all clinical deterioration in long term care facility residents who have positive urine cultures as urinary tract infection, contributing to excess antimicrobial use and heightening the problem of antimicrobial resistance. Recently published guidelines and commentaries attempt to address this problem.

Urinary tract infections in the elderly

Urinary infection is the most common infection in elderly populations. There is a high prevalence of asymptomatic bacteriuria, but this is benign and does not require treatment. A urine specimen for culture should be obtained before initiating antimicrobial therapy for symptomatic infection. Antimicrobial treatment regimens in the elderly are similar to other populations. Chronic indwelling catheters are associated with increased morbidity from urinary tract infection.