Journal of American Geriatrics Society

Yoshikawa, Thomas T.

doi: 10.1046/j.1532-5415.50.7s.1.xpmid: 12121516

Yoshikawa, Thomas T.

doi: 10.1046/j.1532-5415.50.7s.2.xpmid: 12121517

Throughout the history of mankind, infectious diseases have remained a major cause of death and disability. Although industrialized nations, such as the United States, have experienced significant reductions in infection‐related mortality and morbidity since the beginning of the “antibiotic era,” death and complications from infectious diseases remain a serious problem for older persons. Pneumonia is the major infection‐related cause of death in older persons, and urinary tract infection is the most common bacterial infection seen in geriatric patients. Other serious and common infections in older people include intra‐abdominal sepsis, bacterial meningitis, infective endocarditis, infected pressure ulcers, septic arthritis, tuberculosis, and herpes zoster. As a consequence, frequent prescribing of antibiotics for older patients is common practice. The large volume of antibiotics prescribed has contributed to the emergence of highly resistant pathogens among geriatric patients, including methicillin‐resistant Staphylococcus aureus, penicillin‐resistant Streptococcus pneumoniae, vancomycin‐resistant enterococci, and multiple‐drug‐resistant gram‐negative bacilli. Unless preventive strategies coupled with newer drug development are established soon, eventually clinicians will be encountering infections caused by highly resistant pathogens for which no effective antibiotics will be available. Clinicians could then be experiencing the same frustrations of not being able to treat infections effectively as were seen in the “pre‐antibiotic era.”

Nicolle, Lindsay E.

doi: 10.1046/j.1532-5415.50.7s.3.xpmid: 12121518

Antimicrobial susceptibility of bacteria causing urinary tract infection (UTI) has evolved over several decades as antimicrobial exposure has repeatedly been followed by emergence of resistance. Older populations in the community, long‐term care facilities, or acute care facilities have an increased prevalence of resistant bacteria isolated from UTI. Resistant isolates are more frequent in long‐term care populations than the community. Resistant isolates include common uropathogens, such as Escherichia coli or Proteus mirabilis, and organisms with higher levels of intrinsic resistance, such as Pseudomonas aeruginosa or Providencia stuartii. Isolation of resistant organisms is consistently associated with prior antimicrobial exposure and higher functional impairment. The increased likelihood of resistant bacteria makes it essential that a urine specimen for culture and susceptibility testing be obtained before instituting antimicrobial therapy. Therapy for the individual patient must be balanced with the possibility that antimicrobial use will promote further resistance. Antimicrobial therapy should be avoided unless there is a clear clinical indication. In particular, asymptomatic bacteriuria should not be treated with antimicrobials. Where symptoms are mild or equivocal, urine culture results should be obtained before initiating therapy. This permits selection of specific therapy for the infecting organism and avoids empiric, usually broad‐spectrum, therapy. Where empirical therapy is necessary, prior infecting organisms should be isolated, and recent antimicrobial therapy, as well as regional or facility susceptibility patterns, should be considered in antimicrobial choice. Where empirical therapy is used, it should be reassessed 48 to 72 hours after initiation, once pretherapy cultures are available.

Bonomo, Robert A.

doi: 10.1046/j.1532-5415.50.7s.4.xpmid: 12121519

Bronchitis, bronchiectasis, and pneumonia are the most common respiratory tract infections observed in older people and are the leading causes of morbidity and mortality associated with infection. Accurate diagnosis of respiratory tract infections in older people is problematic because of the lack of clear symptoms and signs that are usually seen in younger patients. In addition, the increasing prevalence of bacterial resistance to antibiotic therapy highlights the importance of appropriate therapy. The following review examines the issues associated with the accurate diagnosis of respiratory tract infections, optimal therapy for older patients, and the mechanisms of emerging bacterial resistance to antibiotic therapy.

Norman, Dean C.

doi: 10.1046/j.1532-5415.50.7s.5.xpmid: 12121520

Optimizing the management of antibiotic resistance is an important strategy in improving outcomes for infectious diseases in older persons. Strategies that manage antibiotic resistance must take into account all clinical settings, because resistant pathogens previously seen only in acute care facilities are becoming increasingly common in long‐term care facilities. Recently, modest improvement in therapeutic options for the treatment of infections due to resistant pathogens has become available because of the development of newer antibiotics. Some of these drugs are briefly discussed in this review, but the best strategy is to limit the potential for the development of resistance and transmission of these pathogens. This can best be accomplished by minimizing misuse of antibiotics and maximizing adherence to basic hygiene standards.