Infektionen im Alter - was ist anders?

Abstract

Infectious diseases are a common cause of increased morbidity and mortality in elderly patients and present a frequent problem in the geriatrician's daily practice. Infections in the elderly are quite different from infections in a younger population. These differences are due to Age-related alterations in immunology Different epidemiology and bacteriology Increased morbidity and mortality Altered clinical presentation Concommittant disability and comorbidity in many older patients Different approaches to therapy. This article is an attempt to discuss these various aspects of infectious disease in the elderly. The most important infections in the elderly are caused by bacteria. Incidence and bacterial spectrum depends on the site of infection and whether the patient is hospitalized, living in a nursing home or in the community. Pneumonia, UTI and pressure ulcer infections are more frequent in patients living in nursing homes than in community dwelling older people. Infections are a frequent cause of hospitalization in elderly people and hospitalization on the other hand is a risk factor for life-threatening nosocomial infections, caused by invasive diagnostic procedures and frequent use of urinary and venous catheters. Infections in the elderly are often accompanied by serious complications as bacteriemia (pneumonia), frequent recurrence (UTI), perforation and abscess (abdominal infections) and severe disability (pressure ulcer infections). Because of these serious and frequent complications mortality of infections is higher in older patients than in younger people. Elderly patients with infectious disease often present in the same way as younger patients do. Many elderly however present with non-specific clinical symptoms and non-specific functional decline which makes an accurate diagnosis difficult and may lead to a life-threatening delay of diagnosis and therapy. In older patients with unexplained functional decline, physicians must be aware of the possibility of a serious infection. Moreover, the physician can not rely on typical signs of infections as fever. In the elderly the fever response is often blunted even in the presence of bacteremia. Leokocytosis may be absent and elevation of acute phase protein is a more reliable marker of infection than elevation of erythrocyte sedimentation rate. Clinical suspicion of bacterial infection in elderly patient should prompt Careful anamnesis and clinical investigation Hospitalization if necessary Diagnostic procedures without delay including blood cultures Immediate empiric antibiotic therapy taking into account the site of infection, if the infection is community acquired or nosocomial and the most likely bacterial spectrum and local resistance factors. The use of broad spectrum antibiotic substances with a low side effect profile and pharmacokinetic properties which are suitable for elderly patients.

Clostridium difficile – From Colonization to Infection

“…Secondarily, the higher prevalence of CDI in the elderly could also be associated with the change of the intestinal microbial composition, e.g., loss of bacterial diversity during aging, which might promote C. difficile colonization ( Hopkins et al, 2001 ; Woodmansey, 2007 ). Additionally, the presence of chronic disorders and an increase in the infection rate, requiring polypharmacy, including antibiotics, is generally much higher in this age cohort ( Garibaldi and Nurse, 1986 ; Werner and Kuntsche, 2000 ; Gao et al, 2018 ).…”

Challenges with Diagnosing and Managing Sepsis in Older Adults

“…The most common example is the presence of altered mental status, which is a nonspecific marker of infection in older patients and does not necessarily indicate a nervous system infection as it would in younger adults. Other examples of unique symptoms of infection in older patients include: lethargy, tachypnea, loss of appetite, dehydration, weakness, dizziness, falls, and incontinence 7,23,24 . Finally, due to the presence of multiple comorbid conditions and an increased incidence of delirium in this patient population, it can be challenging to acquire a thorough history of present illness that would normally assist in the initial diagnosis of infection 25 .…”

Pitfalls in the Diagnosis and Therapy of Infections in Elderly Patients – A Mini-Review

“…Frequently, unexplained alterations of behavior, sudden confusion, perception disorders, psychomotoric agitation or lethargy, loss of appetite, dehydration, dizziness, falls and incontinence as well as tachypnea, palpitations, tachycardia, sudden heart failure or focal neurological deficits can be the only indicators of even life-threatening infections [29] .…”