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Infections in the older population: what do we know?

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Abstract

The incidence of infections increases with age and results in a higher risk of morbidity and mortality. This rise is not mainly related to chronological age per se but has been linked mostly to individual factors such as immunosenescence; the presence of comorbidities; the occurrence of geriatric syndromes such as poor nutrition, polypharmacy, and cognitive disorders; and the presence of functional impairment concomitant with environmental, healthcare-related and microbiological factors such as the increasing risk of multidrug-resistant microorganisms. The geriatric concept of frailty introduces a new approach for considering the risk of infection; this concept highlights the importance of functional status and is a more comprehensive and multicomponent approach that may help to reverse the vulnerability to stress. The aim of this article is to provide some typical hallmarks of infections among older adults in comparison to younger individuals. The main differences among the older population that are presented are an increased prevalence of infections and potential risk factors, a higher risk of carrying multidrug-resistant microorganisms, an increase in barriers to a prompt diagnosis related to atypical presentations and challenges with diagnostic tools, a higher risk of under- and over-diagnosis, a worse prognosis with a higher risk of acute and chronic complications and a particular need for better communication among all healthcare sectors as they are closely linked together.

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References

  1. Ward SA, Parikh S, Workman B (2011) Health perspectives: international epidemiology of ageing. Best Pract Res Clin Anaesthesiol 25:305–317. https://doi.org/10.1016/j.bpa.2011.05.002

    Article  PubMed  Google Scholar 

  2. Divo MJ, Martinez CH, Mannino DM (2014) Ageing and the epidemiology of multimorbidity. Eur Respir J 44:1055–1068. https://doi.org/10.1183/09031936.00059814

    Article  PubMed  PubMed Central  Google Scholar 

  3. Drijkoningen JJ, Rohde GG (2014) Pneumococcal infection in adults: burden of disease. Clin Microbiol Infect 20:45–51. https://doi.org/10.1111/1469-0691.12461

    Article  PubMed  Google Scholar 

  4. Foxman B (2014) Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infect Dis Clin North Am 28:1–13. https://doi.org/10.1016/j.idc.2013.09.003

    Article  PubMed  Google Scholar 

  5. Leistner R, Gurntke S, Sakellariou C et al (2014) Bloodstream infection due to extended-spectrum beta-lactamase (ESBL)-positive K. pneumoniae and E. coli: an analysis of the disease burden in a large cohort. Infection 42:991–997. https://doi.org/10.1007/s15010-014-0670-9

    Article  CAS  PubMed  Google Scholar 

  6. Li C, Duan J, Liu S et al (2017) Assessing the risk and disease burden of clostridium difficile infection among patients with hospital-acquired pneumonia at a University Hospital in Central China. Infection 45:621–628. https://doi.org/10.1007/s15010-017-1024-1

    Article  PubMed  PubMed Central  Google Scholar 

  7. You JHS, Choi KW, Wong TY et al (2017) Disease burden, characteristics, and outcomes of methicillin-resistant staphylococcus aureus bloodstream infection in Hong Kong. Asia Pac J Public Health 29:451–461. https://doi.org/10.1177/1010539517717365

    Article  PubMed  Google Scholar 

  8. Evans JG (1994) The role of the physician in geriatric medicine in the ageing society epidemiology. Age Ageing 23:S12–s14

    Article  PubMed  Google Scholar 

  9. Rubenstein LZ, Josephson KR, Wieland GD et al (1984) Effectiveness of a geriatric evaluation unit. A randomized clinical trial. N Engl J Med 311:1664–1670. https://doi.org/10.1056/nejm198412273112604

    Article  CAS  PubMed  Google Scholar 

  10. Stuck AE, Siu AL, Wieland GD et al (1993) Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 342:1032–1036

    Article  CAS  PubMed  Google Scholar 

  11. Baztan JJ, Suarez-Garcia FM, Lopez-Arrieta J et al (2009) Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysis. BMJ 338:b50. https://doi.org/10.1136/bmj.b50

    Article  PubMed  PubMed Central  Google Scholar 

  12. Szyndler A, Derezinski T, Wolf J et al (2019) Impact of orthostatic hypotension and antihypertensive drug treatment on total and cardiovascular mortality in a very elderly community-dwelling population. J Hypertens 37:331–338. https://doi.org/10.1097/HJH.0000000000001878

    Article  CAS  PubMed  Google Scholar 

  13. Buckinx F, Rolland Y, Reginster JY et al (2015) Burden of frailty in the elderly population: perspectives for a public health challenge. Arch Public Health 73:19. https://doi.org/10.1186/s13690-015-0068-x

    Article  PubMed  PubMed Central  Google Scholar 

  14. Schoevaerdts D, Glupczynski Y, Delaere B et al (2007) Effect of a 5-year multidisciplinary collaborative program on antibiotic consumption in an acute geriatric ward. J Am Geriatr Soc 55:145–147. https://doi.org/10.1111/j.1532-5415.2006.01029.x

    Article  PubMed  Google Scholar 

  15. Gavazzi G, Krause KH (2002) Ageing and infection. Lancet Infect Dis 2:659–666

    Article  PubMed  Google Scholar 

  16. Rowe TA, Juthani-Mehta M (2013) Urinary tract infection in older adults. Aging Health. https://doi.org/10.2217/ahe.13.38

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gavazzi G, Mallaret MR, Couturier P et al (2002) Bloodstream infection: differences between young-old, old, and old-old patients. J Am Geriatr Soc 50:1667–1673

    Article  PubMed  Google Scholar 

  18. Kang CI, Song JH, Ko KS et al (2011) Clinical features and outcome of Staphylococcus aureus infection in elderly versus younger adult patients. Int J Infect Dis 15:e58–e62. https://doi.org/10.1016/j.ijid.2010.09.012

    Article  PubMed  Google Scholar 

  19. Michel JP, Lesourd B, Conne P et al (1991) Prevalence of infections and their risk factors in geriatric institutions: a one-day multicentre survey. Bull World Health Organ 69:35–41

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Rothan-Tondeur M, Gavazzi G, Piette F et al (2005) L’Observatoire du Risque Infectieux en Gériatrie. Neurol Psychiatr Gériatr 5:20–25. https://doi.org/10.1016/S1627-4830(05)82548-6

    Article  Google Scholar 

  21. Gordts B, Vrijens F, Hulstaert F et al (2010) The 2007 Belgian national prevalence survey for hospital-acquired infections. J Hosp Infect 75:163–167. https://doi.org/10.1016/j.jhin.2010.01.006

    Article  CAS  PubMed  Google Scholar 

  22. Suetens C, Latour K, Karki T et al (2018) Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016–2017. Eurosurveillance. https://doi.org/10.2807/1560-7917.es.2018.23.46.1800516

    Article  PubMed  PubMed Central  Google Scholar 

  23. Olsen MA, Stwalley D, Demont C et al (2018) Increasing age has limited impact on risk of clostridium difficile infection in an elderly population. Open Forum Infect Dis 5:ofy160. https://doi.org/10.1093/ofid/ofy160

    Article  PubMed  PubMed Central  Google Scholar 

  24. Lang PO, Mitchell WA, Lapenna A et al (2010) Immunological pathogenesis of main age-related diseases and frailty: role of immunosenescence. Eur Geriatr Mecicine 1:112–121. https://doi.org/10.1016/j.eurger.2010.01.010

    Article  Google Scholar 

  25. Fulop T, Larbi A, Witkowski JM (2019) Human inflammaging. Gerontology. https://doi.org/10.1159/000497375

    Article  PubMed  Google Scholar 

  26. Egorov ES, Kasatskaya SA, Zubov VN et al (2018) The changing landscape of naive T cell receptor repertoire with human aging. Front Immunol 9:1618. https://doi.org/10.3389/fimmu.2018.01618

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Liguori I, Russo G, Curcio F et al (2018) Oxidative stress, aging, and diseases. Clin Interv Aging 13:757–772. https://doi.org/10.2147/CIA.S158513

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Ivanov AV, Bartosch B, Isaguliants MG (2017) Oxidative stress in infection and consequent disease. Oxid Med Cell Longev 2017:3496043. https://doi.org/10.1155/2017/3496043

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Santos AL, Sinha S, Lindner AB (2018) The good, the bad, and the ugly of ros: new insights on aging and aging-related diseases from Eukaryotic and prokaryotic model organisms. Oxid Med Cell Longev 2018:1941285. https://doi.org/10.1155/2018/1941285

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Danielsen R, Thorgeirsson G, Einarsson H et al (2017) Prevalence of heart failure in the elderly and future projections: the AGES-Reykjavik study. Scand Cardiovasc J 51:183–189. https://doi.org/10.1080/14017431.2017.1311023

    Article  PubMed  PubMed Central  Google Scholar 

  31. Isoaho R, Puolijoki H, Huhti E et al (1994) Prevalence of chronic obstructive pulmonary disease in elderly Finns. Respir Med 88:571–580

    Article  CAS  PubMed  Google Scholar 

  32. Graham JE, Rockwood K, Beattie BL et al (1997) Prevalence and severity of cognitive impairment with and without dementia in an elderly population. Lancet 349:1793–1796. https://doi.org/10.1016/S0140-6736(97)01007-6

    Article  CAS  PubMed  Google Scholar 

  33. van der Steen JT, Mehr DR, Kruse RL et al (2007) Dementia, lower respiratory tract infection, and long-term mortality. J Am Med Dir Assoc 8:396–403. https://doi.org/10.1016/j.jamda.2007.03.005

    Article  PubMed  Google Scholar 

  34. Thorslund S, Toss G, Nilsson I et al (1990) Prevalence of protein-energy malnutrition in a large population of elderly people at home. Scand J Prim Health Care 8:243–248

    Article  CAS  PubMed  Google Scholar 

  35. Slabaugh SL, Maio V, Templin M et al (2010) Prevalence and risk of polypharmacy among the elderly in an outpatient setting: a retrospective cohort study in the Emilia-Romagna region, Italy. Drugs Aging 27:1019–1028. https://doi.org/10.2165/11584990-000000000-00000

    Article  PubMed  Google Scholar 

  36. Sandberg O, Gustafson Y, Brannstrom B et al (1998) Prevalence of dementia, delirium and psychiatric symptoms in various care settings for the elderly. Scand J Soc Med 26:56–62

    Article  CAS  PubMed  Google Scholar 

  37. Margolis DJ, Bilker W, Knauss J et al (2002) The incidence and prevalence of pressure ulcers among elderly patients in general medical practice. Ann Epidemiol 12:321–325

    Article  PubMed  Google Scholar 

  38. Campbell AJ, Reinken J, McCosh L (1985) Incontinence in the elderly: prevalence and prognosis. Age Ageing 14:65–70

    Article  CAS  PubMed  Google Scholar 

  39. Ashraf M, Biswas J, Gupta S et al (2009) Determinants of wound infections for breast procedures: assessment of the risk of wound infection posed by an invasive procedure for subsequent operation. Int J Surg 7:543–546. https://doi.org/10.1016/j.ijsu.2009.08.012

    Article  CAS  PubMed  Google Scholar 

  40. Pittet D, Hugonnet S, Harbarth S et al (2000) Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet 356:1307–1312

    Article  CAS  PubMed  Google Scholar 

  41. Pearson ML, Bridges CB, Harper SA (2006) Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 55:1–16

    PubMed  Google Scholar 

  42. Clegg A, Young J, Iliffe S et al (2013) Frailty in elderly people. Lancet 381:752–762. https://doi.org/10.1016/S0140-6736(12)62167-9

    Article  PubMed  Google Scholar 

  43. Choi JY, Kim SW, Yoon SJ et al (2018) Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia. Clin Interv Aging 13:2237–2245. https://doi.org/10.2147/CIA.S181400

    Article  PubMed  PubMed Central  Google Scholar 

  44. Yao X, Hamilton RG, Weng NP et al (2011) Frailty is associated with impairment of vaccine-induced antibody response and increase in post-vaccination influenza infection in community-dwelling older adults. Vaccine 29:5015–5021. https://doi.org/10.1016/j.vaccine.2011.04.077

    Article  PubMed  PubMed Central  Google Scholar 

  45. Tavenier J, Margolick JB, Leng SX (2019) T-cell immunity against cytomegalovirus in HIV infection and aging: relationships with inflammation, immune activation, and frailty. Med Microbiol Immunol. https://doi.org/10.1007/s00430-019-00591-z

    Article  PubMed  PubMed Central  Google Scholar 

  46. Schmaltz HN, Fried LP, Xue QL et al (2005) Chronic cytomegalovirus infection and inflammation are associated with prevalent frailty in community-dwelling older women. J Am Geriatr Soc 53:747–754. https://doi.org/10.1111/j.1532-5415.2005.53250.x

    Article  PubMed  Google Scholar 

  47. Mathei C, Vaes B, Wallemacq P et al (2011) Associations between cytomegalovirus infection and functional impairment and frailty in the BELFRAIL Cohort. J Am Geriatr Soc 59:2201–2208. https://doi.org/10.1111/j.1532-5415.2011.03719.x

    Article  PubMed  Google Scholar 

  48. Jimenez Z, Sanchez-Conde M, Branas F (2018) HIV infection as a cause of accelerated aging and frailty. Rev Esp Geriatr Gerontol 53:105–110. https://doi.org/10.1016/j.regg.2017.04.007

    Article  PubMed  Google Scholar 

  49. Desquilbet L, Jacobson LP, Fried LP et al (2007) HIV-1 infection is associated with an earlier occurrence of a phenotype related to frailty. J Gerontol A Biol Sci Med Sci 62:1279–1286

    Article  PubMed  Google Scholar 

  50. Lee SJ, Park SH (2013) Arterial ageing. Korean Circ J 43:73–79. https://doi.org/10.4070/kcj.2013.43.2.73

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Keevil VL, Romero-Ortuno R (2015) Ageing well: a review of sarcopenia and frailty. Proc Nutr Soc 74:337–347. https://doi.org/10.1017/S0029665115002037

    Article  PubMed  Google Scholar 

  52. Ribera-Casado JM (1999) Ageing and the cardiovascular system. Z Gerontol Geriatr 32:412–419

    Article  CAS  PubMed  Google Scholar 

  53. Janssens JP, Pache JC, Nicod LP (1999) Physiological changes in respiratory function associated with ageing. Eur Respir J 13:197–205

    Article  CAS  PubMed  Google Scholar 

  54. Rayner CK, Horowitz M (2013) Physiology of the ageing gut. Curr Opin Clin Nutr Metab Care 16:33–38. https://doi.org/10.1097/MCO.0b013e32835acaf4

    Article  PubMed  Google Scholar 

  55. Schindler JS, Kelly JH (2002) Swallowing disorders in the elderly. Laryngoscope 112:589–602. https://doi.org/10.1097/00005537-200204000-00001

    Article  PubMed  Google Scholar 

  56. Rofes L, Arreola V, Almirall J et al (2011) Diagnosis and management of oropharyngeal Dysphagia and its nutritional and respiratory complications in the elderly. Gastroenterol Res Pract. https://doi.org/10.1155/2011/818979

    Article  PubMed  Google Scholar 

  57. Cabre M, Serra-Prat M, Palomera E et al (2010) Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing 39:39–45. https://doi.org/10.1093/ageing/afp100

    Article  PubMed  Google Scholar 

  58. Macht M, Wimbish T, Clark BJ et al (2012) Diagnosis and treatment of post-extubation dysphagia: results from a national survey. J Crit Care 27:578–586. https://doi.org/10.1016/j.jcrc.2012.07.016

    Article  PubMed  PubMed Central  Google Scholar 

  59. DePippo KL, Holas MA, Reding MJ (1992) Validation of the 3-oz water swallow test for aspiration following stroke. Arch Neurol 49:1259–1261

    Article  CAS  PubMed  Google Scholar 

  60. SFAP-SFGG Group (2007) Troubles de la déglutition chez le sujet âgé en situation palliative. Fiche pratique“Soins Pallitaifs et Gériatrie”(June): http://www.sfap.org/system/files/troubles-deglutition-sujet-age-situation-palliative.pdf

  61. Chen PC, Chuang CH, Leong CP et al (2016) Systematic review and meta-analysis of the diagnostic accuracy of the water swallow test for screening aspiration in stroke patients. J Adv Nurs 72:2575–2586. https://doi.org/10.1111/jan.13013

    Article  PubMed  Google Scholar 

  62. Sund-Levander M, Tingstrom P (2013) Clinical decision-making process for early nonspecific signs of infection in institutionalised elderly persons: experience of nursing assistants. Scand J Caring Sci 27:27–35. https://doi.org/10.1111/j.1471-6712.2012.00994.x

    Article  PubMed  Google Scholar 

  63. Bonomo RA, Rice LB (1999) Emerging issues in antibiotic resistant infections in long-term care facilities. J Gerontol A Biol Sci Med Sci 54:B260–B267

    Article  CAS  PubMed  Google Scholar 

  64. Schoevaerdts D, Verroken A, Huang TD et al (2012) Multidrug-resistant bacteria colonization amongst patients newly admitted to a geriatric unit: a prospective cohort study. J Infect 65:109–118. https://doi.org/10.1016/j.jinf.2012.02.004

    Article  PubMed  Google Scholar 

  65. Pop-Vicas A, Mitchell SL, Kandel R et al (2008) Multidrug-resistant gram-negative bacteria in a long-term care facility: prevalence and risk factors. J Am Geriatr Soc 56:1276–1280. https://doi.org/10.1111/j.1532-5415.2008.01787.x

    Article  PubMed  Google Scholar 

  66. Trick WE, Weinstein RA, DeMarais PL et al (2001) Colonization of skilled-care facility residents with antimicrobial-resistant pathogens. J Am Geriatr Soc 49:270–276

    Article  CAS  PubMed  Google Scholar 

  67. Aliyu S, Smaldone A, Larson E (2017) Prevalence of multidrug-resistant gram-negative bacteria among nursing home residents: a systematic review and meta-analysis. Am J Infect Control 45:512–518. https://doi.org/10.1016/j.ajic.2017.01.022

    Article  PubMed  Google Scholar 

  68. Pujol M, Pena C, Pallares R (1996) Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-susceptible strains. Am J Med 100:509–516

    Article  CAS  PubMed  Google Scholar 

  69. Schwaber MJ, Carmeli Y (2007) Mortality and delay in effective therapy associated with extended-spectrum beta-lactamase production in Enterobacteriaceae bacteraemia: a systematic review and meta-analysis. J Antimicrob Chemother 60:913–920. https://doi.org/10.1093/jac/dkm318

    Article  CAS  PubMed  Google Scholar 

  70. Suetens C, Niclaes L, Jans B et al (2006) Methicillin-resistant Staphylococcus aureus colonization is associated with higher mortality in nursing home residents with impaired cognitive status. J Am Geriatr Soc 54:1854–1860. https://doi.org/10.1111/j.1532-5415.2006.00972.x

    Article  PubMed  Google Scholar 

  71. Krcmery V, Hricak V, Fischer V et al (2019) Etiology, risk factors and outcome of 1003 cases of infective endocarditis from a 33-year National Survey in the Slovak Republic: an increasing proportion of elderly patients. Neuro Endocrinol Lett 39:544–549

    PubMed  Google Scholar 

  72. Woodhead M (1994) Pneumonia in the elderly. J Antimicrob Chemother 34:85–92

    Article  PubMed  Google Scholar 

  73. Harper C, Newton P (1989) Clinical aspects of pneumonia in the elderly veteran. J Am Geriatr Soc 37:867–872

    Article  CAS  PubMed  Google Scholar 

  74. Swenson BR, Hedrick TL, Popovsky K et al (2007) Is fever protective in surgical patients with bloodstream infection? J Am Coll Surg 204:815–821. https://doi.org/10.1016/j.jamcollsurg.2007.01.033 (Discussion 822-813)

  75. Castle SC, Norman DC, Yeh M et al (1991) Fever response in elderly nursing home residents: are the older truly colder? J Am Geriatr Soc 39:853–857

    Article  CAS  PubMed  Google Scholar 

  76. Lindsay JM, Greenough WB 3rd, Zelesnick LB et al (1994) Fever in the nursing home resident. Md Med J 43:159–164

    CAS  PubMed  Google Scholar 

  77. Norman C (2016) Clinical faitures of infection in older adults. Clin Geriatr Med 32:433–441. https://doi.org/10.1016/j.cger.2016.02.005

    Article  PubMed  Google Scholar 

  78. Yahav D, Schlesinger A, Daitch V et al (2015) Presentation of infection in older patients—a prospective study. Ann Med 47:354–358. https://doi.org/10.3109/07853890.2015.1019915

    Article  PubMed  Google Scholar 

  79. Yahav D, Schlesinger A, Shaked H et al (2017) Clinical presentation, management and outcomes of Staph aureus bacteremia (SAB) in older adults. Aging Clin Exp Res 29:127–133. https://doi.org/10.1007/s40520-016-0543-4

    Article  PubMed  Google Scholar 

  80. Martin GS, Mannino DM, Moss M (2006) The effect of age on the development and outcome of adult sepsis. Crit Care Med 34:15–21. https://doi.org/10.1097/01.ccm.0000194535.82812.ba

    Article  PubMed  Google Scholar 

  81. Valencia AM, Vallejo CE, Alvarez ALL et al (2017) Attenuation of the physiological response to infection on adults over 65 years old admitted to the emergency room (ER). Aging Clin Exp Res 29:847–856. https://doi.org/10.1007/s40520-016-0679-2

    Article  PubMed  Google Scholar 

  82. Loeb M (2004) Pneumonia in the elderly. Curr Opin Infect Dis 17:127–130

    Article  PubMed  Google Scholar 

  83. Sun G, Okada M, Nakamura R et al (2019) Twenty-four-hour continuous and remote monitoring of respiratory rate using a medical radar system for the early detection of pneumonia in symptomatic elderly bedridden hospitalized patients. Clin Case Rep 7:83–86. https://doi.org/10.1002/ccr3.1922

    Article  PubMed  Google Scholar 

  84. Courjon J, Lemaignen A, Ghout I et al (2017) Pyogenic vertebral osteomyelitis of the elderly: characteristics and outcomes. PLoS One 12:e0188470. https://doi.org/10.1371/journal.pone.0188470

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  85. Mayne S, Bowden A, Sundvall PD et al (2019) The scientific evidence for a potential link between confusion and urinary tract infection in the elderly is still confusing—a systematic literature review. BMC Geriatr 19:32. https://doi.org/10.1186/s12877-019-1049-7

    Article  PubMed  PubMed Central  Google Scholar 

  86. Saukkoriipi A, Palmu AA, Jokinen J (2019) Culture of all sputum samples irrespective of quality adds value to the diagnosis of pneumococcal community-acquired pneumonia in the elderly. Eur J Clin Microbiol Infect Dis. https://doi.org/10.1007/s10096-019-03536-9

    Article  PubMed  PubMed Central  Google Scholar 

  87. Fein AM (1999) Pneumonia in the elderly: overview of diagnostic and therapeutic approaches. Clin Infect Dis 28:726–729. https://doi.org/10.1086/515218

    Article  CAS  PubMed  Google Scholar 

  88. Bentley DW (1984) Bacterial pneumonia in the elderly: clinical features, diagnosis, etiology, and treatment. Gerontology 30:297–307. https://doi.org/10.1159/000212649

    Article  CAS  PubMed  Google Scholar 

  89. Zhang CY, Zhao F, Xia YY et al (2019) Prevalence and risk factors of active pulmonary tuberculosis among elderly people in China: a population based cross-sectional study. Infect Dis Poverty 8:7. https://doi.org/10.1186/s40249-019-0515-y

    Article  PubMed  PubMed Central  Google Scholar 

  90. Battista G, Palmarini D, Casadei A et al (2003) Diagnostic imaging of pneumonia in the elderly. Radiol Med 106:75–82

    PubMed  Google Scholar 

  91. Edge JR, Millard FJ, Reid L et al (1964) The radiographic appearances of the chest in persons of advanced age. Br J Radiol 37:769–774. https://doi.org/10.1259/0007-1285-37-442-769

    Article  CAS  PubMed  Google Scholar 

  92. Franquet T (2018) Imaging of community-acquired pneumonia. J Thorac Imaging 33:282–294. https://doi.org/10.1097/RTI.0000000000000347

    Article  PubMed  Google Scholar 

  93. Minnaard MC, de Groot JAH, Hopstaken RM et al (2017) The added value of C-reactive protein measurement in diagnosing pneumonia in primary care: a meta-analysis of individual patient data. CMAJ 189:E56–E63. https://doi.org/10.1503/cmaj.151163

    Article  PubMed  PubMed Central  Google Scholar 

  94. Karasahin O, Tasar PT, Timur O et al (2018) The value of C-reactive protein in infection diagnosis and prognosis in elderly patients. Aging Clin Exp Res 30:555–562. https://doi.org/10.1007/s40520-017-0821-9

    Article  PubMed  Google Scholar 

  95. Lee WJ, Woo SH, Kim DH et al (2016) Are prognostic scores and biomarkers such as procalcitonin the appropriate prognostic precursors for elderly patients with sepsis in the emergency department? Aging Clin Exp Res 28:917–924. https://doi.org/10.1007/s40520-015-0500-7

    Article  PubMed  Google Scholar 

  96. Wang Y, Zhang S, Li L et al (2019) The usefulness of serum procalcitonin, C-reactive protein, soluble triggering receptor expressed on myeloid cells 1 and Clinical Pulmonary Infection Score for evaluation of severity and prognosis of community-acquired pneumonia in elderly patients. Arch Gerontol Geriatr 80:53–57. https://doi.org/10.1016/j.archger.2018.10.005

    Article  CAS  PubMed  Google Scholar 

  97. Stucker F, Herrmann F, Graf JD et al (2005) Procalcitonin and infection in elderly patients. J Am Geriatr Soc 53:1392–1395. https://doi.org/10.1111/j.1532-5415.2005.53421.x

    Article  PubMed  Google Scholar 

  98. van Duin D (2012) Diagnostic challenges and opportunities in older adults with infectious diseases. Clin Infect Dis 54:973–978. https://doi.org/10.1093/cid/cir927

    Article  PubMed  Google Scholar 

  99. Lee SH, Chan RC, Wu JY et al (2013) Diagnostic value of procalcitonin for bacterial infection in elderly patients—a systemic review and meta-analysis. Int J Clin Pract 67:1350–1357. https://doi.org/10.1111/ijcp.12278

    Article  PubMed  Google Scholar 

  100. Lai CC, Chen SY, Wang CY et al (2010) Diagnostic value of procalcitonin for bacterial infection in elderly patients in the emergency department. J Am Geriatr Soc 58:518–522. https://doi.org/10.1111/j.1532-5415.2010.02730.x

    Article  PubMed  Google Scholar 

  101. Yan L, Liao P, Xu LL et al (2014) Usefulness of procalcitonin in elderly patients with bacterial infection. Clin Lab 60:139–142

    Article  PubMed  Google Scholar 

  102. Yang Y, Hao Q, Flaherty JH et al (2018) Comparison of procalcitonin, a potentially new inflammatory biomarker of frailty, to interleukin-6 and C-reactive protein among older Chinese hospitalized patients. Aging Clin Exp Res 30:1459–1464. https://doi.org/10.1007/s40520-018-0964-3

    Article  PubMed  Google Scholar 

  103. Rodhe N, Molstad S, Englund L et al (2006) Asymptomatic bacteriuria in a population of elderly residents living in a community setting: prevalence, characteristics and associated factors. Fam Pract 23:303–307. https://doi.org/10.1093/fampra/cml007

    Article  PubMed  Google Scholar 

  104. Hedin K, Petersson C, Wideback K et al (2002) Asymptomatic bacteriuria in a population of elderly in municipal institutional care. Scand J Prim Health Care 20:166–168

    Article  PubMed  Google Scholar 

  105. Zalmanovici Trestioreanu A, Lador A, Sauerbrun-Cutler MT et al (2015) Antibiotics for asymptomatic bacteriuria. Cochrane Database Syst Rev 4:CD009534. https://doi.org/10.1002/14651858.cd009534.pub2

    Article  PubMed  Google Scholar 

  106. Hartley S, Valley S, Kuhn L et al (2015) Overtreatment of asymptomatic bacteriuria: identifying targets for improvement. Infect Control Hosp Epidemiol 36:470–473. https://doi.org/10.1017/ice.2014.73

    Article  PubMed  Google Scholar 

  107. Blakiston M, Zaman S (2014) Nosocomial bacteriuria in elderly inpatients may be leading to considerable antibiotic overuse: an audit of current management practice in a secondary level care hospital in New Zealand. Infect Drug Resist 7:301–308. https://doi.org/10.2147/IDR.S66036

    Article  PubMed  PubMed Central  Google Scholar 

  108. Latour K, Catry B, Broex E et al (2012) Indications for antimicrobial prescribing in European nursing homes: results from a point prevalence survey. Pharmacoepidemiol Drug Saf 21:937–944. https://doi.org/10.1002/pds.3196

    Article  PubMed  Google Scholar 

  109. Loeb M, Brazil K, Lohfeld L et al (2005) Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomisedrandomized controlled trial. BMJ 331:669. https://doi.org/10.1136/bmj.38602.586343.55

    Article  PubMed  PubMed Central  Google Scholar 

  110. Falcone M, Tiseo G, Dentali F (2019) Early alert from microbiology laboratory improves the outcome of elderly patients with Enterococcus spp bacteremia: results from a multicenter prospective study. J Glob Antimicrob Resist. https://doi.org/10.1016/j.jgar.2019.02.014

    Article  PubMed  Google Scholar 

  111. Lee CC, Chen SY, Chang IJ et al (2007) Comparison of clinical manifestations and outcome of community-acquired bloodstream infections among the oldest old, elderly, and adult patients. Medicine (Baltimore) 86:138–144. https://doi.org/10.1097/SHK.0b013e318067da56

    Article  CAS  Google Scholar 

  112. Bula CJ, Ghilardi G, Wietlisbach V et al (2004) Infections and functional impairment in nursing home residents: a reciprocal relationship. J Am Geriatr Soc 52:700–706. https://doi.org/10.1111/j.1532-5415.2004.52205.x

    Article  PubMed  Google Scholar 

  113. Cebrian-Cuenca AM, Diez-Domingo J, San-Martin-Rodriguez M et al (2011) Epidemiology and cost of herpes zoster and postherpetic neuralgia among patients treated in primary care centres in the Valencian community of Spain. BMC Infect Dis 11:302. https://doi.org/10.1186/1471-2334-11-302

    Article  PubMed  PubMed Central  Google Scholar 

  114. Mareque M, Oyaguez I, Morano R et al (2019) Systematic review of the evidence on the epidemiology of herpes zoster: incidence in the general population and specific subpopulations in Spain. Public Health 167:136–146. https://doi.org/10.1016/j.puhe.2018.10.015

    Article  CAS  PubMed  Google Scholar 

  115. Kawai K, Yawn BP (2017) Risk factors for herpes zoster: a systematic review and meta-analysis. Mayo Clin Proc 92:1806–1821. https://doi.org/10.1016/j.mayocp.2017.10.009

    Article  PubMed  Google Scholar 

  116. Bricout H, Haugh M, Olatunde O et al (2015) Herpes zoster-associated mortality in Europe: a systematic review. BMC Public Health 15:466. https://doi.org/10.1186/s12889-015-1753-y

    Article  PubMed  PubMed Central  Google Scholar 

  117. Lu WH, Lin CW, Wang CY et al (2018) Epidemiology and long-term disease burden of herpes zoster and postherpetic neuralgia in Taiwan: a population-based, propensity score-matched cohort study. BMC Public Health 18:369. https://doi.org/10.1186/s12889-018-5247-6

    Article  PubMed  PubMed Central  Google Scholar 

  118. Studahl M, Petzold M, Cassel T (2013) Disease burden of herpes zoster in Sweden–predominance in the elderly and in women—a register based study. BMC Infect Dis 13:586. https://doi.org/10.1186/1471-2334-13-586

    Article  PubMed  PubMed Central  Google Scholar 

  119. Drolet M, Oxman MN, Levin MJ et al (2013) Vaccination against herpes zoster in developed countries: state of the evidence. Hum Vaccin Immunother 9:1177–1184. https://doi.org/10.4161/hv.23491

    Article  PubMed  PubMed Central  Google Scholar 

  120. Katz J, Cooper EM, Walther RR et al (2004) Acute pain in herpes zoster and its impact on health-related quality of life. Clin Infect Dis 39:342–348. https://doi.org/10.1086/421942

    Article  PubMed  Google Scholar 

  121. Jung BF, Johnson RW, Griffin DR et al (2004) Risk factors for postherpetic neuralgia in patients with herpes zoster. Neurology 62:1545–1551

    Article  PubMed  Google Scholar 

  122. Schmidt-Ott R, Schutter U, Simon J et al (2018) Incidence and costs of herpes zoster and postherpetic neuralgia in German adults aged >/=50 years: a prospective study. J Infect 76:475–482. https://doi.org/10.1016/j.jinf.2018.02.001

    Article  PubMed  Google Scholar 

  123. Opstelten W, Mauritz JW, de Wit NJ et al (2002) Herpes zoster and postherpetic neuralgia: incidence and risk indicators using a general practice research database. Fam Pract 19:471–475

    Article  PubMed  Google Scholar 

  124. Cunningham AL, Lal H, Kovac M et al (2016) Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or older. N Engl J Med 375:1019–1032. https://doi.org/10.1056/NEJMoa1603800

    Article  CAS  PubMed  Google Scholar 

  125. Lal H, Cunningham AL, Godeaux O et al (2015) Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med 372:2087–2096. https://doi.org/10.1056/NEJMoa1501184

    Article  PubMed  Google Scholar 

  126. Lim WS, van der Eerden MM, Laing R et al (2003) Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 58:377–382

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  127. Baek MS, Park S, Choi JH et al (2019) Mortality and prognostic prediction in very elderly patients with severe pneumonia. J Intensiv Care Med. https://doi.org/10.1177/0885066619826045

    Article  Google Scholar 

  128. Bloom AS, Suchindran S, Steinbrink J et al (2019) Utility of predictive tools for risk stratification of elderly individuals with all-cause acute respiratory infection. Infection. https://doi.org/10.1007/s15010-019-01299-1

    Article  PubMed  Google Scholar 

  129. De Silva TR, Theou O, Vellas B et al (2018) Frailty Screening (FRAIL-NH) and mortality in french nursing homes: results from the incidence of pneumonia and related consequences in nursing home residents study. J Am Med Dir Assoc 19:411–414. https://doi.org/10.1016/j.jamda.2017.12.101

    Article  PubMed  Google Scholar 

  130. Moro ML, Jans B, Cookson B et al (2010) The burden of healthcare-associated infections in European long-term care facilities. Infect Control Hosp Epidemiol 31:S59–s62. https://doi.org/10.1086/655989

    Article  PubMed  Google Scholar 

  131. Rooney PJ, O’Leary MC, Loughrey AC et al (2009) Nursing homes as a reservoir of extended-spectrum beta-lactamase (ESBL)-producing ciprofloxacin-resistant Escherichia coli. J Antimicrob Chemother 64:635–641. https://doi.org/10.1093/jac/dkp220

    Article  CAS  PubMed  Google Scholar 

  132. Jans B, Schoevaerdts D, Huang TD et al (2013) Epidemiology of multidrug-resistant microorganisms among nursing home residents in Belgium. PLoS One 8:e64908. https://doi.org/10.1371/journal.pone.0064908

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  133. Latour K, Huang TD, Jans B et al (2019) Prevalence of multidrug-resistant organisms in nursing homes in Belgium in 2015. PLoS One 14:e0214327. https://doi.org/10.1371/journal.pone.0214327

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  134. Lapane KL, Dubé CE, Pakyz AL (2016) Entangled practices, entangled epidemics: antibiotic practices and healthcare associated infections in nursing homes and hospitals. J Nurs Home Res Sci 2:21–26. https://doi.org/10.14283/jnhrs.2016.3

    Article  Google Scholar 

  135. Ricchizzi E, Latour K, Karki T et al (2018) Antimicrobial use in European long-term care facilities: results from the third point prevalence survey of healthcare-associated infections and antimicrobial use 2016 to 2017. EuroSurveill 23:1–2. https://doi.org/10.2807/1560-7917.es.2018.23.46.1800394

    Article  Google Scholar 

  136. McClean P, Hughes C, Tunney M et al (2011) Antimicrobial prescribing in European nursing homes. J Antimicrob Chemother 66:1609–1616. https://doi.org/10.1093/jac/dkr183

    Article  CAS  PubMed  Google Scholar 

  137. Al-Taani GM, Scott M, Farren D et al (2018) Longitudinal point prevalence survey of antibacterial use in Northern Ireland using the European Surveillance of Antimicrobial Consumption (ESAC) PPS and Global-PPS tool. Epidemiol Infect 146:985–990. https://doi.org/10.1017/S095026881800095X

    Article  CAS  PubMed  Google Scholar 

  138. Inouye SK, Studenski S, Tinetti ME et al (2007) Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc 55:780–791. https://doi.org/10.1111/j.1532-5415.2007.01156.x

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Geriatric Department, CHU UCL Namur, Site Godinne, Avenue Dr. Gaston Thérasse, 1, B-5530, Yvoir, Belgium

    Didier Schoevaerdts, François-Xavier Sibille & Gaetan Gavazzi

  2. Service Gériatrie Clinique, Centre Hospitalo-Universitaire Grenoble-Alpes, Avenue Central 621, 38400, Saint-Martin-d’Hères, France

    Gaetan Gavazzi

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  1. Didier Schoevaerdts
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Schoevaerdts, D., Sibille, FX. & Gavazzi, G. Infections in the older population: what do we know?. Aging Clin Exp Res 33, 689–701 (2021). https://doi.org/10.1007/s40520-019-01375-4

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