Special considerations of antibiotic prescription in the geriatric population

Beckett, Carolyn; Harbarth, Stéphan Juergen; Huttner, Benedikt

doi:10.1016/j.cmi.2014.08.018

Cited by 81 publications

(77 citation statements)

References 70 publications

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“…Explanations given for this hypothesis are altered physiological responses to the infecting pathogen in this patient group, and age-related changes in temperature regulation. 6 The results of studies reporting on sepsis presentation in the elderly and in comparison with younger patients are presented below (Table 1).…”

Section: Presentation Of Bsimentioning

confidence: 99%

“…57 Contributing factors to high rates of colonization and infection of elderly with MDROs include substantial antimicrobial exposure, frequent hospitalizations, indwelling devices, dementia and low functional status, and as a result -high rates of cross transmission in these settings. 6,58 Dekinger et al demonstrated that among patients aged 65 and older admitted to hospital, rates of MDROs are approximately 2-fold higher for MRSA and vancomycin resistant enterococci (VRE) and 3-fold higher for multidrug resistant (MDR) Gram negative compared to younger patients. In this study, during 2009, 57% of Staph aureus isolates were methicillin resistant, 25% of enterococcal isolates were vancomycin resistant and 14% of gram-negative isolates were multidrug resistant.…”

Section: Antimicrobial Resistancementioning

confidence: 99%

“…5 Elderly patients in institutions are at higher risk for infections because of more pronounced impairment of defenses against infection and large number of comorbidities, in addition to higher risk for rapid dissemination of viral infections and multidrug resistant organisms. 6 …”

Section: Infections In Older Patientsmentioning

confidence: 99%

“…11,35 In nursing home residents with an indwelling catheter, risk of UTI with each day that the catheter remains in place have been reported 3-7%. 6 Prevalence of urinary catheters use in skilled nursing facilities range between 6 and 40%, depending on the population studied. 36 In a study evaluating patients with community acquired BSIs, 40% of UTI cases occurred in patients with an indwelling urinary catheter.…”

Section: Source Of Bsismentioning

confidence: 99%

“…42,51 In these institutions antibiotic resistance is a growing problem and outbreaks of infection with multidrug resistant organisms (MDROs) are frequently reported. 6,42 Long-term care facilities may play an important role in the spread of resistant organisms, including Klebsiella pneumonia carbapenemase (KPC)-producing Enterobacteriaceae, 52 extended spectrum b-lactamase (ESBL) producing organisms, 53 metallo-b-lactamase (MBL) producing, 54 MRSA, 55 VRE and MDR Acinetobacter baumanii. 56 March et al found that among LTCF residents in 2012, 54% were colonized with 1 resistant organism.…”

Section: Antimicrobial Resistancementioning

confidence: 99%

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Bloodstream infections in older patients

et al. 2016

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Section: Presentation Of Bsimentioning

confidence: 99%

Section: Antimicrobial Resistancementioning

confidence: 99%

Section: Infections In Older Patientsmentioning

confidence: 99%

Section: Source Of Bsismentioning

confidence: 99%

Section: Antimicrobial Resistancementioning

confidence: 99%

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Bloodstream infections in older patients

et al. 2016

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Understanding the gut microbiota and sarcopenia: a systematic review

Liu

Cheung

et al. 2021

J cachexia sarcopenia muscle

180

100

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Background Gut microbiota dysbiosis and sarcopenia commonly occur in the elderly. Although the concept of the gut–muscle axis has been raised, the casual relationship is still unclear. This systematic review analyses the current evidence of gut microbiota effects on muscle/sarcopenia. Methods A systematic review was performed in PubMed, Embase, Web of Science, and The Cochrane Library databases using the keywords (microbiota* OR microbiome*) AND (sarcopen* OR muscle). Studies reporting the alterations of gut microbiota and muscle/physical performance were analysed. Results A total of 26 pre‐clinical and 10 clinical studies were included. For animal studies, three revealed age‐related changes and relationships between gut microbiota and muscle. Three studies focused on muscle characteristics of germ‐free mice. Seventy‐five per cent of eight faecal microbiota transplantation studies showed that the recipient mice successfully replicated the muscle phenotype of donors. There were positive effects on muscle from seven probiotics, two prebiotics, and short‐chain fatty acids (SCFAs). Ten studies investigated on other dietary supplements, antibiotics, exercise, and food withdrawal that affected both muscle and gut microbiota. Twelve studies explored the potential mechanisms of the gut–muscle axis. For clinical studies, 6 studies recruited 676 elderly people (72.8 ± 5.6 years, 57.8% female), while 4 studies focused on 244 young adults (29.7 ± 7.8 years, 55.4% female). The associations of gut microbiota and muscle had been shown in four observational studies. Probiotics, prebiotics, synbiotics, fermented milk, caloric restriction, and exercise in six studies displayed inconsistent effects on muscle mass, function, and gut microbiota. Conclusions Altering the gut microbiota through bacteria depletion, faecal transplantation, and various supplements was shown to directly affect muscle phenotypes. Probiotics, prebiotics, SCFAs, and bacterial products are potential novel therapies to enhance muscle mass and physical performance. Lactobacillus and Bifidobacterium strains restored age‐related muscle loss. Potential mechanisms of microbiome modulating muscle mainly include protein, energy, lipid, and glucose metabolism, inflammation level, neuromuscular junction, and mitochondrial function. The role of the gut microbiota in the development of muscle loss during aging is a crucial area that requires further studies for translation to patients.

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What influences antibiotic initiation? Developing a scale to measure nursing behaviour in residential aged‐care facilities

Singh,

Degeling,

Drury

et al. 2024

Nursing Open

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AimThe purpose of the current study was to develop and assess the psychometric properties of a measure that captures nursing behaviours that have the potential to influence the initiation of antibiotics in residential aged‐care facilities.DesignCross‐sectional online survey.MethodOne hundred and fifty‐seven nurses completed an online survey. The survey consisted of two clinical vignettes and measures of tolerance of uncertainty and anxiety. The vignettes consisted of the most common presentations (urinary tract infections and upper respiratory tract infections) of two hypothetical residents in aged‐care facilities. The vignettes provided participants with incremental information with varying levels of symptoms, input from other people and availability of test results. Both vignettes were subjected to exploratory factor analysis.ResultsThe results focus on the 16 items in the second vignette which resulted in the extraction of three factors. The derived factors were labelled as follows: (i) Noting and Calling GP, (ii) Consult a Colleague and (iii) Immediate Assessment and Antibiotics. Reliability analysis revealed excellent to satisfactory reliability. All three scales were significantly correlated with measures of clinical tolerance of uncertainty, and the ‘noting and calling GP’ scale was also negatively correlated with measures of anxiety and general tolerance of uncertainty. The measure showed satisfactory reliability and validity for capturing nursing behaviours that have the potential to influence decisions regarding antibiotics. As such, the current study provides a first step towards addressing the lack of ecologically valid measures that capture the complex and nuanced context of nurses’ behaviours in RACF that have the potential to inform future stewardship interventions.

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Special considerations of antibiotic prescription in the geriatric population

Cited by 81 publications

References 70 publications

Bloodstream infections in older patients

Bloodstream infections in older patients

Understanding the gut microbiota and sarcopenia: a systematic review

What influences antibiotic initiation? Developing a scale to measure nursing behaviour in residential aged‐care facilities

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