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Potentially serious infections in the aging person: diagnosis, treatment and prevention
Carmen R Ballesté1, Glenda González, Carlos H Ramírez-Ronda
1Infectious Diseases Program, San Juan Veterans Affairs Medical Center, University District Hospital-Department of Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
Abstract:
Infections in the elderly patient are a challenge, since the classical signs of infection are absent or ill defined. The present paper describes the presentation, diagnosis, clinical manifestations and treatment for a selected group of potential serious infections including influenza, bacterial pneumonia, urinary tract infections as well as infections caused by multiresistant bacteria, like vacomycin-resistant enterococcus and methicillin resistant S. aureus. We conclude with the need for prevention in the older person with the use of vaccines, specifically the influenza and pneumococcal vaccine as well as the prevention of urinary infections. Influenza is a significant cause of morbidity, whose ill effects can be prevented in many older persons with the use of a vaccine. The use in prophylaxis and treatment of antiviral agents like amantadine, rimatadine, and oseltamivir is presented. Bacterial pneumonia is one of the leading causes of death in the USA among the older persons. The emergence of drug resistant Streptococcus pneumoniae leads to the consideration as empiric therapy the newer fluoroquinolones or the use of third or fourth generation cephalosporis. Of importance is the use of pneumococcal vaccine among people age 60 or above. The frequency of urinary tract infections among the elderly is of primary although in many instances important do not require treatment. When infection of the urinary tract is diagnosed, most authors use a fluoroquinolone as empiric theraphy. The emergence of multiresistant bacteria like methicillin resistant S. aureus and or vancomycin resistant enterococci leads to the need to consider new agents like quinipristin-dalfopristin, linezolid and deptomycin in the management of such patients.
Insights
Elderly infections present unique challenges due to atypical symptoms. Prevention through vaccination and prompt treatment of conditions like influenza, pneumonia, and UTIs are crucial for better outcomes in older adults.
Area of Science:
- Geriatrics
- Infectious Diseases
- Public Health
Background:
- Infections in elderly patients often lack typical signs, complicating diagnosis and management.
- Older adults are susceptible to serious infections including influenza, pneumonia, and urinary tract infections (UTIs).
- The rise of multidrug-resistant organisms (MDROs) like vancomycin-resistant enterococcus and methicillin-resistant Staphylococcus aureus poses significant treatment challenges.
Purpose of the Study:
- To describe the presentation, diagnosis, clinical manifestations, and treatment of serious infections in the elderly.
- To highlight the importance of preventive strategies, including vaccination and infection control.
- To discuss the management of infections caused by multidrug-resistant bacteria in older individuals.
Main Methods:
- Review of clinical presentations, diagnostic approaches, and therapeutic options for common and severe infections in the elderly.
- Discussion of antimicrobial resistance patterns and the role of newer antimicrobial agents.
- Emphasis on the role of vaccines, specifically influenza and pneumococcal vaccines, in prevention.
Main Results:
- Influenza and bacterial pneumonia are significant causes of morbidity and mortality in older adults.
- Urinary tract infections are frequent, with fluoroquinolones often used as empiric therapy.
- Multidrug-resistant bacteria necessitate consideration of novel therapeutic agents such as linezolid and daptomycin.
Conclusions:
- Vaccination (influenza, pneumococcal) is vital for preventing serious infections in the elderly.
- Prompt and appropriate treatment, considering antimicrobial resistance, is essential.
- Preventive measures for UTIs and vigilant management of MDROs are critical for improving geriatric infectious disease care.
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