Geriatric Infectious Diseases: Current Concepts on Diagnosis and Management

Yoshikawa, Thomas T.; Norman, Dean C.

doi:10.1111/jgs.14731

Cited by 68 publications

(73 citation statements)

References 103 publications

(209 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The increased rate of UTIs in older KT recipients mirrors results of those reported in a case‐control study in the literature assessing infection in younger and older KT recipients . With advancing age, we expect functional and dynamic outflow changes that predispose to UTIs, and a higher frequency of bacteria in the urine . Given this increased vulnerability of older adults to UTIs and given the effect of immunosuppression is typically highest during the first year after KT, the high incidence of UTIs in the older KT population is not unexpected .…”

Section: Discussionsupporting

confidence: 65%

“…Given the higher prevalence of CVD and diabetes mellitus in the older age group, this was an unexpected finding . Notably, pneumonia, which is a common infection and cause of mortality in older adults, was not more frequent in older adults in the post–kidney transplant setting whereas UTIs and CMV viremia were. In addition, while there was not more rejection in the older recipients, there was significantly higher mortality, longer transplant hospitalizations and decrease in functional status during the first year post‐transplant.…”

Section: Discussionmentioning

confidence: 93%

See 1 more Smart Citation

Infections after kidney transplantation. Does age matter?

Hemmersbach‐Miller

Alexander

Sudan

et al. 2019

Clinical Transplantation

View full text Add to dashboard Cite

Infections threaten successful outcomes after kidney transplantation. Our aim was to determine if the number, types of infections and the risk factors for common infections differed between older compared to younger kidney transplant (KT) recipients in the first year after surgery. We performed a single‐center retrospective cohort study. Between 2011 and 2015, 91 KTs were performed in patients ≥65 years of age; these were matched 1:1 (by year of transplantation, sex and race) to controls aged 40‐60 years. Over 90% of both groups had an infectious complication. Urinary tract infections (UTIs) and cytomegalovirus (CMV) viremia were significantly more frequent in older recipients. Older adults had more late onset UTIs, including after stent removal. CMV viremia was more frequent in older adults in the 1‐6 months post‐transplant period. Due to our center‐specific protocol utilizing pre‐emptive monitoring in the CMV recipient‐seropositive population, the higher CMV incidence in the aged recipient was driven by this subpopulation of older adults. No difference in pneumonias or bloodstream infections were found, nor in surgical complications, rejection or graft loss. Mortality was higher at 1‐year post‐transplant in the older recipients (9.9% vs 1.1%; P = 0.018). Prophylactic and immunosuppressive strategies may need to be altered for older KT recipients.

show abstract

Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 93%

Infections after kidney transplantation. Does age matter?

Hemmersbach‐Miller

Alexander

Sudan

et al. 2019

Clinical Transplantation

View full text Add to dashboard Cite

show abstract

“…Seven articles included in this review focused on outbreaks, which give rise to estimates that are likely higher than typically observable in LTCFs. The definition of an outbreak also varies markedly across studies by geography, type of respiratory infection, population involved, time, and more [43]. Many outbreaks are generally defined as an infection incidence exceeding an expected rate.…”

Section: / 691mentioning

confidence: 99%

“…Converse to the potential overestimation of infection rates by outbreak data, data sources like administrative claims capture only some of the most severe infections and likely underestimate the burden of respiratory infections. Administrative data may identify even fewer respiratory infection events among LTCF residents because signs and symptoms of acute infection are often not proportional to the severity of illness [43]. Interpretation of the literature is further complicated by the atypical presentation of infections in frail older adults [44].…”

Section: / 691mentioning

confidence: 99%

The burden of respiratory infections among older adults in long-term care: a systematic review

et al. 2019

View full text Add to dashboard Cite

Background Respiratory infections among older adults in long-term care facilities (LTCFs) are a major global concern, yet a rigorous systematic synthesis of the literature on the burden of respiratory infections in the LTCF setting is lacking. To address the critical need for evidence regarding the global burden of respiratory infections in LTCFs, we assessed the burden of respiratory infections in LTCFs through a systematic review of the published literature. Methods We identified articles published between April 1964 and March 2019 through searches of PubMed (MEDLINE), EMBASE, and the Cochrane Library. Experimental and observational studies published in English that included adults aged ≥60 residing in LTCFs who were unvaccinated (to identify the natural infection burden), and that reported measures of occurrence for influenza, respiratory syncytial virus (RSV), or pneumonia were included. Disagreements about article inclusion were discussed and articles were included based on consensus. Data on study design, population, and findings were extracted from each article. Findings were synthesized qualitatively. Results A total of 1451 articles were screened for eligibility, 345 were selected for full-text review, and 26 were included. Study population mean ages ranged from 70.8 to 90.1 years. Three (12%) studies reported influenza estimates, 7 (27%) RSV, and 16 (62%) pneumonia. Eighteen (69%) studies reported incidence estimates, 7 (27%) prevalence estimates, and 1 (4%) both. Seven (27%) studies reported outbreaks. Respiratory infection incidence estimates ranged from 1.1 to 85.2% and prevalence estimates ranging from 1.4 to 55.8%. Influenza incidences ranged from 5.9 to 85.2%. RSV incidence proportions ranged from 1.1 to 13.5%. Pneumonia prevalence proportions ranged from 1.4 to 55.8% while incidence proportions ranged from 4.8 to 41.2%. Conclusions The reported incidence and prevalence estimates of respiratory infections among older LTCF residents varied widely between published studies. The wide range of estimates offers little useful guidance for decision-making to decrease respiratory infection burden. Large, well-designed epidemiologic studies are therefore still necessary to credibly quantify the burden of respiratory infections among older adults in LTCFs, which will ultimately help inform future surveillance and intervention efforts. Electronic supplementary material The online version of this article (10.1186/s12877-019-1236-6) contains supplementary material, which is available to authorized users.

show abstract

“…The incidence of a number of infections appears to increase in old age (Yoshikawa 2000;Schneider 1983;Gardner 1980;Yoshikawa and Norman 2017;Bender 2003;Meyers 1989). There are three possible causes for this pattern.…”

Section: Introductionmentioning

confidence: 99%

Geriatric infections: Decreased immunity or evolved opportunists?

et al. 2020

View full text Add to dashboard Cite

In host-parasite co-evolution, parasites are assumed to have an advantage owing to their shorter generation time. Evolution of pathogens within the lifetime of a host individual is implicated as a strong selective force in the evolution of sex and aging in the host. However, this assumption or its testable predictions have not been examined empirically. We classified infectious bacteria and viruses into those that can have continued longterm existence on the host body (group 1) versus those that have only a short-term interaction during an active infection (group 2). We surveyed the literature for age-specific incidence data about infections from both the groups. The age trends of the two groups show contrasting patterns. The incidence of infections by all group 1 pathogens showed a 2.28-to 28-fold increase in older ages. In group 2, 6 out of the 9 pathogens showed a significant declining trend in incidence with age. In both groups, there was greater mortality or morbidity among the infected in the old-age classes. These patterns are better explained by pathogen evolution than by age-related decline in immunity.(0123456789().,-volV) (0123456789().,-volV)

show abstract

Geriatric Infectious Diseases: Current Concepts on Diagnosis and Management

Cited by 68 publications

References 103 publications

Infections after kidney transplantation. Does age matter?

Infections after kidney transplantation. Does age matter?

The burden of respiratory infections among older adults in long-term care: a systematic review

Geriatric infections: Decreased immunity or evolved opportunists?

Contact Info

Product

Resources

About