Infectious diseases and antibiotic resistance in long-term care facilities

Infectious diseases in the institutionalized elderly are emerging as 1 of the major issues challenging physicians treating adult patients. The most common syndromes encountered are nursing home-acquired pneumonia, urinary tract infections, and skin and soft tissue infections. As a complicating factor, immunocompromised elderly patients are often infected with bacteria highly resistant to antibiotics. The use of broad-spectrum agents in the nursing home may be accelerating this process. Developing algorithms for appropriate treatment of nursing home-acquired infections, assessing the factors that encourage the development of resistance, and finding interventions that can stem these processes are urgent priorities. Important clinical research questions include determining how frequently elderly patients are colonized with multiresistant pathogens and how these pathogens disseminate in this population. The future possibility of altering the aging immune system still remains an elusive goal.