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OU Geriatrics Spring 2018 > Infectious Diseases in the Elderly > Flashcards

Infectious Diseases in the Elderly Flashcards

1
Q

important infections in the elderly

A
  • Pneumonia
  • UTI
  • Intra-abdominal infections
  • Soft tissue infections
  • Endocarditis
  • meningitis
  • septic arthritis
  • Tuberculosis
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2
Q

Pneumonia

A

leading cause of death in hospitalized elderly, fifth leading cause of death in people > 65

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3
Q

UTI

A

most frequent bacterial infection in the elderly, most common cause of sepsis in the elderly

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4
Q

Intra-abdominal infections

A

diverticulitis and cholecystitis are more common in the elderly

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5
Q

Soft tissue infections

A

pressure ulcers and surgical wound infections are more common in the elderly

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6
Q

Tuberculosis

A

probably more common in the elderly due to relapse associated with immunodeficiency of old age and causes greater mortality in the elderly

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7
Q

What is one way that pressure ulcers can be avoided?

A

constantly turning the pt

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8
Q

Factors Which Increase the Risk of Infections in the Elderly

A
  • Diminished humoral and cellular immunity
  • Decreased blood perfusion of organs
  • Decreased cough reflex
  • Thinning of skin
  • More and longer hospitalizations
  • Dementia and stroke increases risk of pneumonia, UTI and soft tissue infections
  • lack of clearance of sputum
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9
Q

Unique Features of Infectious Diseases in the Elderly

A
  • Fever, leukocytosis, left shift may be absent
  • Cough or sputum production may be absent in the older people with pneumonia (may not have the physical strength to cough)
  • Frequency or burning may be absent in older people with urinary tract infections
  • Anorexia, cognitive impairment, fatigue, weight loss, decline in functional status, falls, hypotension are non-specific symptoms commonly seen in older people with infections
  • Empiric therapy is recommended as soon as infection is suspected accompanied by obtaining objective information
  • Resolution after initiation of appropriate therapy is prolonged in the elderly
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10
Q

What are common etiologies of bronchitis?

A
  • Influenza virus
  • Adenovirus
  • Coronavirus
  • Parainfluenza virus
  • Mycoplasma pneumoniae
  • Bordetella pertussis (rare)
  • Chlamydia pneumoniae
  • Streptococcus pneumoniae (often 2º)
  • Haemophilus influenzae (often 2º)
  • Moraxella catarrhalis (often 2º)
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11
Q

What are the ways in which pneumonia can be acquired in the elderly?

A
  • Community acquired
  • Hospital acquired
  • Nursing home acquired
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12
Q

What are common pathogens of pneumonia in CAP?

A
  • S. pneumoniae
  • H. influenzae
  • Klebsiella sp
  • M. catarrhalis
  • S. aureus
  • Often preceded by viral infections
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13
Q

What is the difference between in-pt and out-pt treatment of CAP?

A

same but in-pt uses IV formulations

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14
Q

treatment of CAP

A
  • Macrolides (azithromycin or clarithromycin)
  • Fluoroquinolone with S. pneumoniae activity – moxifloxacin, gatifloxacin, levofloxacin or gemifloxacin
  • Beta-lactam (high dose amoxicillin, high dose amoxacillin/clavulanate, cefpodoxime, cefprozil or cefuroxime)
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15
Q

What are common pathogens of pneumonia in HAP?

A
  • Klebsiella sp
  • E. coli
  • Enterobacter sp
  • Pseudomonas aeruginosa
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16
Q

Prevention of Pneumonia in the Elderly

A
  • Pneumococcal vaccination: PCV 13 first, followed by 12 months later of PPSV23
  • Influenza vaccination (high dose) or prevention (oseltamivir (Tamiflu), zanamivir (Relenza) or oseltamivir + rimantadine combination when resistance is prevalent)
17
Q

symptomatic bacteriuria

A

manifesting as typical symptoms (frequency, burning) or functional decline, cognitive impairment, or anorexia

18
Q

What is the lab value that defines bacteriuria?

A

> 10^5 cfu/ml

19
Q

When do you treat bacteriuria?

A
  • symptomatic pts

- if pt has symptoms and a catheter, treat only if symptoms of UTI cannot be explained by other causes

20
Q

When should diagnostic evaluation be warranted?

A
  • elderly men with recurrent UTI, upper tract infection, or sepsis
  • recurrence of UTI in women
  • note: Chronic bacterial prostatitis should be excluded in elderly men with recurrent UTI
21
Q

Duration of treatment of UTI

A
  • generally 3 days but 7 to 10 days may be more appropriate for elderly women and 2 weeks for elderly men
  • recurrent UTI may require up to 6 weeks of therapy
22
Q

What are the most common organism causing UTI in the elderly?

A
  • E. Coli
  • Proteus spp
  • Klebsiella spp
  • Enterococcus spp
23
Q

Treatment of UTI (uncomplicated)

A
  • Trimethoprim / sulfamethoxazole
  • First generation cephalosporin
  • Amoxicillin/clavulanate
  • Quinolone
24
Q

Treatment of UTI (complicated)

A
  • Second or third generation cephalosporin
  • Aztreonam
  • Quinolone
  • Aminoglycoside + Ampicillin
25
Q

Prevention of UTI’s in the elderly

A
  • Adequate fluid intake (cranberry juice?)
  • Topical vaginal estrogen in women
  • Condom catheters for men versus indwelling catheters
  • Prophylactic antibiotics
26
Q

When is prophylactic antibiotics appropriate?

A
  • Indicated if ≥ 2 UTIs in 6 months or ≥ 3 UTIs in 12 months
  • Shown to decrease recurrence
  • Duration 6 months (TMP, TMP/SMX, nitrofurantoin, norfloxacin)
27
Q

What is the duration or therapy for it to be considered chronic?

A

> 90 days

28
Q

Concerns about chronic nitrofurantoin in the elderly

A
  • Beers list medication
  • Concerns about increased risk of pulmonary, hepatotoxicity and peripheral neuropathy; risk increased with renal insufficiency.
  • Of limited value if CrCl< 30 ml/min (new guideline)
  • Development of resistance. Avoid prolonged use for prophylaxis
29
Q

Discuss infections in the long term care setting

A
  • Over 1.5 million infections annually
  • Approximately 1-2 infections per resident per year
  • Most frequent reason for transfer to hospital
  • Responsible for 25% of hospitalization from LTC
30
Q

Prevention and Minimization of Infections in Nursing Homes

A
  • Management strategies

- Patient care strategies

31
Q

Management strategies

A
  • Infection control program: Surveillance, Outbreak investigation
  • Antimicrobial utilization program
  • Employee health program
32
Q

Patient care strategies

A
  • Optimal management of associated diseases
  • Optimal nutrition
  • Avoidance of invasive devices
  • Vaccinations: Influenza, Pneumococcus, Tetanus
  • Screening : Tuberculosis

OU Geriatrics Spring 2018 (9 decks)

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