Influence of Aging and Environment on Presentation of Infection in Older Adults

Chakhtoura, Nadim G. El; Bonomo, Robert A.; Jump, Robin L.P.

doi:10.1016/j.idc.2017.07.017

Cited by 87 publications

(75 citation statements)

References 70 publications

(112 reference statements)

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“…can potentially explain why they are more likely to receive antibiotics based on exhibited symptoms rather than an actual infection diagnosis. 20,21 In the current study, the highest rates of antibiotic prescribing occurred in the South and the highest rates of inappropriate prescribing occurred in the during the winter, which is consistent with other studies. 5,[22][23][24][25] There are many factors that may explain regional and seasonal trends.…”

Section: Discussionsupporting

confidence: 91%

National Trends in Oral Antibiotic Prescribing in United States Physician Offices from 2009 to 2016

et al. 2020

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BACKGROUND Prior studies have found that outpatient antibiotics are commonly prescribed for nonbacterial conditions. It is unclear if national prescribing has changed in recent years given recent public health and antimicrobial stewardship initiatives. This study aimed to describe antibiotic prescribing in United States (U.S.) physician offices. MATERIALS/METHODS This was a cross-sectional study of all sampled patient visits in the Centers for Disease Control and Prevention's National Ambulatory Medical Care Survey from 2009 to 2016. Antibiotic use was defined as at least one oral antibiotic prescription during the visit as identified by Multum code(s). Patient visits were categorized by U.S. geographic region and season. ICD-9-CM and ICD-10 codes were used to assess diagnoses and categorize antibiotic use as appropriate, possibly appropriate, or inappropriate. RESULTS Seven billion visits were included for analysis, with 793,415,182 (11.3%) including an antibiotic. Prescribing rates were relatively stable over the study period (102.9-124.9 prescriptions per 1000 visits); however, 2016 had one of the lowest prescribing rates (107.7 per 1000 visits). The most commonly prescribed antibiotic class was macrolides (25 per 1000 visits). The South region and winter season had the highest antibiotic prescribing (118.2 and 129.7 per 1000 visits, respectively). Of patients who received an antibiotic, 55.9%, 35.7%, and 8.4% were classified as inappropriate, possibly appropriate, and appropriate, respectively. The most common conditions in which antibiotics were prescribed inappropriately included those with no indication in any of the predefined diagnosis codes (40.1%), other skin conditions (17.3%), and viral upper respiratory conditions (13.3%). CONCLUSIONS There was no significant reduction in outpatient antibiotic prescribing rates among U.S. outpatients from 2009 to 2016 and prescribing varied by region and season. These data suggest that more than half of antibiotics were prescribed inappropriately, with the majority of antibiotics prescribed with no indication. However, these findings need to be confirmed with robust prospective studies.

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Section: Discussionsupporting

confidence: 91%

National Trends in Oral Antibiotic Prescribing in United States Physician Offices from 2009 to 2016

et al. 2020

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“…In this study, caregivers who were over 50 years old accounted for 47.1% of the total participants, 16.2% of whom were more than 60 years old, which is a concern. This is because to the best of our knowledge, the physical function of this population is reduced, and their immune system has changed due to aging [23,24] . Repeated and close exposure to MDRO inpatients increases the risk of infection [16] .…”

Section: Discussionmentioning

confidence: 99%

Hand hygiene compliance among caregivers of inpatients with multidrug-resistant organism infection in China: a cross-sectional study

Chang¹,

Chen²,

Wang³

et al. 2020

Preprint

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Background Caregivers are an important provider of daily living care for multidrug-resistant organism (MDRO) inpatients in China, they are at risk for contracting and spreading MDRO from frequent interactions with patients. Improving the hand hygiene (HH) compliance of caregivers has important significance in reducing the incidence of infection. However, we have little information about HH compliance among caregivers of MDRO inpatients in most medical institutions. Therefore, we decide to examine HH compliance among caregivers of MDRO inpatients in China. Methods Using direct observations, we investigated HH compliance among caregivers of MDRO inpatients between March and August 2019 in a large university-affiliated hospital in China. Using the WHO’s Hand Hygiene Observation Tool, we surveyed a total of 440 HH opportunities. Results Out of the total participants, 16.2% were elderly. Overall HH compliance was 46.8%. The most frequent moment for HH was “after a touching patient” (69.2%) and the lowest compliance was “before clean/aseptic procedures” (25.6%). Compliance during “visiting” was highest (66.7%), with hands being less frequently washed during “resting” (29.0%). Conclusions Overall compliance with HH when caring for MDRO inpatients is less than optimal. Elderly caregivers should be valued by society and the public. These results may be used to identify issues and interventions to address HH practices and achieve a reduction in MDRO infections.

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“…Elderly patients may in fact not develop the typical fever seen in SARS-CoV-2 infection due to a blunted response caused by immune senescence. 10 'Silent hypoxaemia', the phenomenon whereby patients develop hypoxaemia and respiratory failure without dyspnoea or respiratory distress, is another unusual presentation of COVID-19 that appears to particularly affect the elderly population. 11 This is an especially worrying presentation as patients may feel well and therefore not present to hospital, and then subsequently precipitously deteriorate due to their hypoxaemia, thus leading to treatment delay and adverse outcomes.…”

Section: Covid-19 In the Elderly: Including Deliriummentioning

confidence: 99%

COVID-19: to be or not to be; that is the diagnostic question

Coleman

Manavi

Marson

et al. 2020

Postgraduate Medical Journal

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Since the first cases in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread across the globe, resulting in the COVID-19 pandemic. Early clinical experiences have demonstrated the wide spectrum of SARS-CoV-2 presentations, including various reports of atypical presentations of COVID-19 and possible mimic conditions.This article summarises the current evidence surrounding atypical presentations of COVID-19 including neurological, cardiovascular, gastrointestinal, otorhinolaryngology and geriatric features. A case from our hospital of pneumocystis pneumonia initially suspected to be COVID-19 forms the basis for a discussion surrounding mimic conditions of COVID-19. The dual-process model of clinical reasoning is used to analyse the thought processes used to make a diagnosis of COVID-19, including consideration of the variety of differential diagnoses.While SARS-CoV-2 is likely to remain on the differential diagnostic list for a plethora of presentations for the foreseeable future, clinicians should be cautious of ignoring other potential diagnoses due to availability bias. An awareness of atypical presentations allows SARS-CoV-2 to be a differential so that it can be appropriately investigated. A knowledge of infectious mimics prevents COVID-19 from overshadowing other diagnoses, hence preventing delayed diagnosis or even misdiagnosis and consequent adverse outcomes for patients.

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Influence of Aging and Environment on Presentation of Infection in Older Adults

Cited by 87 publications

References 70 publications

National Trends in Oral Antibiotic Prescribing in United States Physician Offices from 2009 to 2016

National Trends in Oral Antibiotic Prescribing in United States Physician Offices from 2009 to 2016

Hand hygiene compliance among caregivers of inpatients with multidrug-resistant organism infection in China: a cross-sectional study

COVID-19: to be or not to be; that is the diagnostic question

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