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Infections in the Elderly - Coggle Diagram
Infections in the Elderly
Vulnerablity
Mor frequent hospital admissions
Longer hospital stays
Higher mortality
High total hospiral costs
More comorbidities
Recurrent infections
Bluntd physiological response to infection
Peak temps and max WBC counts
Reduced cough reflex, stomach acid, circulation, wound healing
Immune Senescence
Skin
Decreased TNF α by macrophages
Decreased neutrophil recruitment
Disease
Impaired wound healing
Liver
Increased NK T-cell cytokine production
Disease
Liver inflammation in response to viral infection or PAMPs
Vasculature
Increased cytokine (IL_6) producation by VSMC
Disease
Atherosclerosis
Brain
Increased microglial activation
Increased activtion of TLR and inflammasome pathways
Disease
Neurodegeneration
Lungs
Decreased NK function
iNCREASED pgd2 LEVELS
Decreased NLRP3 function
Disease
Infections with respiratory pathogens
Increased chronic lung disease
Adipose tissue
Dysregulated cytokines
Disease
Metabolic syndrome
Insulin resistance
Nutrition: Protein-Energy Malnutrition
30-60% of admissions over 65 yrs have PEM
Increased risks
Delayed wound healing
Pressure ulcer formation
Community aquired pneumonia
Nosocomial infx
UTIs
More common in women
Do not treat as asymptomatic bacteriuria
Prevention
Remove catheters where possible
Cranberry juice
Topical oestrogen
Adhesion blockers
RTIs
Pneumonia
CURB-65
Score
Estimates mortality of community-acquired pneumonia to help determine inpatient vs. outpatient treatment
Confusion - new onset
Urea > 7mmol/l
Resp rate >30 breaths/min
BP <90/60
AGE >65
Scoring
0-1 Treat as outpatient
2 - Consider admission / follow closely as outpatient
More than 3 requires hospitalization
Mortality >17%
Streptococcus Pneumonia (Pneumococcus)
Disease
Strep pneumonia
Often ocurs as 2ndary pneumonia after the flu
Detection
Urinary antigen
Tx
Mild cases: Amoxicillin / clarithromycin if sensitive
Severe cases: Ceftriaxone / cefetoaxime
All >65: Pneumococcal vaccine (Polysaccharide)
Under 2yrs: PVC vaccine (conjugate vaccine)
Skin Infections
GI Infections
C. difficile
Gram +
Spore forming bacillus
Anaerobe
Spread by touch / faecal oral
Disease
Pseudomembranous colitis
Tx
IV Metronidazole
PO vancomycin
Fidaxomicin for recurrent cases
Faecal microbiota transplant successful in 93% of pt
E.coli
Tx
Carbapenem to treat ESBL producing bacteria
Can result in cabapenamase producing E. coli however
Antibiotic Resistance
Social and Environmental Factors
Lower socioeconomic status (SES) associated with CAP
Medication Presrcibing
Vancomycin and Gentamicin Dosing
Ototoxic and nephrotoxic
Assess renal fx by urea and creatine levels
Zoster Vaccine
Live attenuated viral vaccine in those >50 yrs
