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Surgical Site Infections in Older Adults

Epidemiology and Management Strategies

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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.

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Acknowledgements

This work was supported in part by VA Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center (GRECC) and the John A. Hartford Foundation’s Center of Excellence. No other sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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Correspondence to Preeti N. Malani.

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Young, M.H., Washer, L. & Malani, P.N. Surgical Site Infections in Older Adults. Drugs Aging 25, 399–414 (2008). https://doi.org/10.2165/00002512-200825050-00004

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