Soft Tissue Infections in the Elderly

Chapter

Abstract

Elderly patients already face declining physiologic reserve and frequently have one or more comorbidities. They may face barriers to accessing medical care that result in delay in the diagnosis and treatment of their necrotizing soft tissue infection (NSTI). Sepsis, commonly seen with NSTI carries a higher mortality rate in elderly patients. Hospital complication and comorbidities also contirbute the overall higher mortality seen in the geriatric patient population. Even after discharge from the hospital, geriatric patients have more decline in social and physical functioning than younger patients. Recovery following amputation is a particular challenge for older patients and they may not regain their independence.

Keywords

Necrotizing infection Necrotizing fasciitis Soft-tissue infection 

References

  1. 1.
    Edelsberg J, Taneja C, Zervos M, Haque N, Moore C, Reyes K, et al. Trends in US hospital admissions for skin and soft tissue infections. Emerg Infect Dis. 2009;15(9):1516–8.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Necrotizing fasciitis: a rare disease, especially for the healthy. 2015. http://www.cdc.gov/features/necrotizingfasciitis/. Accessed 7 Mar 2016.
  3. 3.
    Mills MK, Faraklas I, Davis C, Stoddard GJ, Saffle J. Outcomes from treatment of necrotizing soft-tissue infections: results from the National Surgical Quality Improvement Program database. Am J Surg. 2010;200(6):790–6; discussion 796–7.Google Scholar
  4. 4.
    Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg. 1996;224(5):672–83.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Morgan MS. Diagnosis and management of necrotising fasciitis: a multiparametric approach. J Hosp Infect. 2010;75(4):249–57.CrossRefPubMedGoogle Scholar
  6. 6.
    Shiroff AM, Herlitz GN, Gracias VH. Necrotizing soft tissue infections. J Intensive Care Med. 2014;29(3):138–44.CrossRefPubMedGoogle Scholar
  7. 7.
    Incidence of diagnosed diabetes per 1,000 population aged 18–79 years, by sex and age, United States, 1997–2014. 2015. http://www.cdc.gov/diabetes/statistics/incidence/fig5.htm. Accessed 7 Mar 2016.
  8. 8.
    SEER incidence and U.S. death rates, age-adjusted and age-specific rates, by race and sex. http://seer.cancer.gov/csr/1975_2012/browse_csr.php?sectionSEL=2&pageSEL=sect_02_table.07.html. Accessed 7 Mar 2016.
  9. 9.
    Active Bacterial Core Surveillance (ABCs) report emerging infections program network group A streptococcus, provisional—2014. 2015. http://www.cdc.gov/abcs/reports-findings/survreports/gas14.pdf. Accessed 24 Mar 2016.
  10. 10.
    Kuo YL, Shieh SJ, Chiu HY, Lee JW. Necrotizing fasciitis caused by Vibrio vulnificus: epidemiology, clinical findings, treatment and prevention. Eur J Clin Microbiol Infect Dis. 2007;26(11):785–92.CrossRefPubMedGoogle Scholar
  11. 11.
    McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg. 1995;221(5):558–63; discussion 563–5.Google Scholar
  12. 12.
    Coleman S, Gorecki C, Nelson EA, Closs SJ, Defloor T, Halfens R, et al. Patient risk factors for pressure ulcer development: systematic review. Int J Nurs Stud. 2013;50(7):974–1003.CrossRefPubMedGoogle Scholar
  13. 13.
    Gould L, Abadir P, Brem H, Carter M, Conner-Kerr T, Davidson J, et al. Chronic wound repair and healing in older adults: current status and future research. Wound Repair Regen. 2015;23(1):1–13.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Rates of TBI-related Emergency Department Visits by Age Group—United States, 2001–2010. 2016. http://www.cdc.gov/traumaticbraininjury/data/rates_ed_byage.html. Accessed 7 Mar 2016.
  15. 15.
    Anaya DA, McMahon K, Nathens AB, Sullivan SR, Foy H, Bulger E. Predictors of mortality and limb loss in necrotizing soft tissue infections. Arch Surg. 2005;140(2):151–7; discussion 158.Google Scholar
  16. 16.
    Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG. Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Arch Intern Med. 1995;155(5):469–73.CrossRefPubMedGoogle Scholar
  17. 17.
    Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005;15(3):175–84.CrossRefPubMedGoogle Scholar
  18. 18.
    Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535–41.CrossRefPubMedGoogle Scholar
  19. 19.
    Wall DB, Klein SR, Black S, de Virgilio C. A simple model to help distinguish necrotizing fasciitis from nonnecrotizing soft tissue infection. J Am Coll Surg. 2000;191(3):227–31.CrossRefPubMedGoogle Scholar
  20. 20.
    Patel KV. Epidemiology of anemia in older adults. Semin Hematol. 2008;45(4):210–7.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Mohan S, Gu S, Parikh A, Radhakrishnan J. Prevalence of hyponatremia and association with mortality: results from NHANES. Am J Med. 2013;126(12):1127–37. e1CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Tiao JY, Semmens JB, Masarei JR, Lawrence-Brown MM. The effect of age on serum creatinine levels an aging population: relevance to vascular surgery. Cardiovasc Surg. 2002;10(5):445–51.CrossRefPubMedGoogle Scholar
  23. 23.
    Wysoki MG, Santora TA, Shah RM, Friedman AC. Necrotizing fasciitis: CT characteristics. Radiology. 1997;203(3):859–63.CrossRefPubMedGoogle Scholar
  24. 24.
    Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011;8(1):30–41.CrossRefPubMedGoogle Scholar
  25. 25.
    Akinbami L, Liu X. Chronic obstructive pulmonary disease among adults aged 18 and over in the United States, 1998–2009. 2015. http://www.cdc.gov/nchs/data/databriefs/db63.htm. Accessed 7 Mar 2015.
  26. 26.
  27. 27.
    Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. Crit Care Med. 2006;34(1):15–21.CrossRefPubMedGoogle Scholar
  28. 28.
    Emori TG, Banerjee SN, Culver DH, Gaynes RP, Horan TC, Edwards JR, et al. Nosocomial infections in elderly patients in the United States, 1986–1990. National Nosocomial Infections Surveillance System. Am J Med. 1991;91(3B):289S–93S.CrossRefPubMedGoogle Scholar
  29. 29.
    Freischlag JA, Ajalat G, Busuttil RW. Treatment of necrotizing soft tissue infections. The need for a new approach. Am J Surg. 1985;149(6):751–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am. 2003;85-A(8):1454–60.CrossRefPubMedGoogle Scholar
  31. 31.
    Neveu H, Kleinknecht D, Brivet F, Loirat P, Landais P. Prognostic factors in acute renal failure due to sepsis. Results of a prospective multicentre study. The French Study Group on Acute Renal Failure. Nephrol Dial Transplant. 1996;11(2):293–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Fitzpatrick AL, Powe NR, Cooper LS, Ives DG, Robbins JA. Barriers to health care access among the elderly and who perceives them. Am J Public Health. 2004;94(10):1788–94.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Nursing Home Care. 2015. http://www.cdc.gov/nchs/fastats/nursing-home-care.htm. Accessed 7 Mar 2016.
  34. 34.
    Light TD, Choi KC, Thomsen TA, Skeete DA, Latenser BA, Born JM, et al. Long-term outcomes of patients with necrotizing fasciitis. J Burn Care Res. 2010;31(1):93–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Bulger EM, Maier RV, Sperry J, Joshi M, Henry S, Moore FA, et al. A novel drug for treatment of necrotizing soft-tissue infections: a randomized clinical trial. JAMA Surg. 2014;149(6):528–36.CrossRefPubMedGoogle Scholar
  36. 36.
    Xu J, Murphy S, Kochanek K, Bastian B. Deaths: final data for 2013. 2016. http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf. Accessed 7 Mar 2016.
  37. 37.
    Helm P, Engel T, Holm A, Kristiansen VB, Rosendahl S. Function after lower limb amputation. Acta Orthop Scand. 1986;57(2):154–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Purser JL, Weinberger M, Cohen HJ, Pieper CF, Morey MC, Li T, et al. Walking speed predicts health status and hospital costs for frail elderly male veterans. J Rehabil Res Dev. 2005;42(4):535–46.CrossRefPubMedGoogle Scholar
  39. 39.
    Robinovitch SN, Feldman F, Yang Y, Schonnop R, Leung PM, Sarraf T, et al. Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study. Lancet. 2013;381(9860):47–54.CrossRefPubMedGoogle Scholar
  40. 40.
    Gell NM, Wallace RB, LaCroix AZ, Mroz TM, Patel KV. Mobility device use in older adults and incidence of falls and worry about falling: findings from the 2011–2012 national health and aging trends study. J Am Geriatr Soc. 2015;63(5):853–9.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Coletta EM. Care of the elderly patient with lower extremity amputation. J Am Board Fam Pract. 2000;13(1):23–34.CrossRefPubMedGoogle Scholar
  42. 42.
    Vogel TR, Petroski GF, Kruse RL. Impact of amputation level and comorbidities on functional status of nursing home residents after lower extremity amputation. J Vasc Surg. 2014;59(5):1323–30. e1CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Pikturnaite J, Soldin M. Impact of necrotising fasciitis on quality of life: a qualitative analysis. Burns. 2014;40(5):848–51.CrossRefPubMedGoogle Scholar
  44. 44.
    Hakkarainen TW, Burkette Ikebata N, Bulger E, Evans HL. Moving beyond survival as a measure of success: understanding the patient experience of necrotizing soft-tissue infections. J Surg Res. 2014;192(1):143–9.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Program in Trauma University of Maryland School of Medicine, University of Maryland Medical Center R A Cowley Shock Trauma CenterBaltimoreUSA

Personalised recommendations