Drugs & Aging

, Volume 25, Issue 5, pp 399–414

Surgical Site Infections in Older Adults

Epidemiology and Management Strategies

Authors

  • Michael H. Young
    • Division of Infectious Diseases, Department of Internal MedicineUniversity of Kentucky Medical Center
  • Laraine Washer
    • Division of Infectious Diseases, Department of Internal MedicineUniversity of Michigan Health System
    • Division of Infectious Diseases, Department of Internal MedicineUniversity of Michigan Health System
    • Division of Geriatric Medicine, Department of Internal MedicineUniversity of Michigan Health System
    • Veterans Affairs Ann Arbor Healthcare System
    • Geriatric Research Education and Clinical Center (GRECC)
Review Article

DOI: 10.2165/00002512-200825050-00004

Cite this article as:
Young, M.H., Washer, L. & Malani, P.N. Drugs Aging (2008) 25: 399. doi:10.2165/00002512-200825050-00004

Abstract

Surgical site infections (SSIs) represent a major source of morbidity and mortality among older adults. In this review we discuss the epidemiology and risk factors for SSIs among older adults. We also offer an overview of current treatment and management strategies for several common SSIs. Our comments focus on the following areas in order to illustrate issues of clinical importance in the older patient: (i) cardiac surgery; (ii) vascular grafts; (iii) total joint arthroplasty; (iv) breast surgery; and (v) spinal surgeries. Besides being common and relatively specific to older adults, several of these surgical procedures require the use of prosthetic materials or devices, which present unique treatment challenges in the context of infection. When an older adult does develop an SSI, it is critical for clinicians to establish an overall treatment goal for each patient. In the majority of patients, this will be either complete cure or remission followed by suppressive therapy. However, clinicians caring for older adults must consider not only the possibility of microbiological cure, but also balance the need to preserve functional status and overall quality of life. Infections associated with devices and prosthetic material can present unique treatment challenges. Treatment of significant infections often requires prolonged courses of parenteral and/or oral antimicrobial therapy, which can raise issues related to the safety and tolerability of antimicrobial agents, including higher rates of nephrotoxicity. Issues concerning overall functional status, nutritional reserve and medical co-morbidities must be taken into consideration when approaching SSIs in an older adult.

Copyright information

© Adis Data Information BV 2008