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Infections in Elderly Care

Infections in Elderly Care. Dr Lucia Pareja-Cebrian Microbiology Consultant 12 th March 2014. Who Why What. WHO. Difficult cutoff point: ?65, ?70 ?85 Aging population 1900s: 1% of world’s population (15 m) >65yo 1992: 6% of population (342 m) >65 yo 2020: 20% of population (6b) >65 yo

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Infections in Elderly Care

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  1. Infections in Elderly Care Dr Lucia Pareja-Cebrian Microbiology Consultant 12th March 2014

  2. Who • Why • What

  3. WHO • Difficult cutoff point: ?65, ?70 ?85 • Aging population • 1900s: 1% of world’s population (15 m) >65yo • 1992: 6% of population (342 m) >65 yo • 2020: 20% of population (6b) >65 yo • >85 are high risk group

  4. WHY • Decline in host defences • Inmune senescence • Changes in non adaptive inmunity • Chronic illness • Medication • Malnutrition • Functional impairments

  5. Immunity • T-cell production decreases with age • Antibody production decrease • Malnutrition affects cell mediated immunity

  6. Non adaptive immunity • Thining skin, chronic ulcers • Enlarged prostate • Impaired cough reflex • Functional impairments: • Dysphagia • Inmobility • Incontinence

  7. Chronic illness and intervention • Diabetes • Hypertension • Dementia • Decreased gastric acid • Indwelling devices, medication,

  8. Lifestyle • Leisure: travelling, gardening, sports? • Contact with healthcare: Outpatients, inpatients? • Living arrangements: nursing homes, residential care?

  9. Sitting ducks or sentinel chickens?

  10. WHAT? • Skin and soft tissue • UTIs and the “new kids on the block” • ESBLs • Carbapenemases • GI • Respiratory • HCAI • Vaccine preventable

  11. The trouble with infections… …is it a bird, is it a plane…? …is it a UTI, is it a chest infection…?!

  12. Challenges in diagnosis • Temperature response • Communication • Immune response • Pain • Confusion

  13. Skin and soft Tissue • Thining skin • Chronic ulcers • Colonisation vs infection? • Organisms involved: • Streptococcus (A,B,G, C) • Staph aureus (MRSA)

  14. UTI • No benefit in treating asymptomatic UTI • …symptoms are hard to spot! • How long to treat: • 3 days for uncomplicated UTI • 5-7 days in males • 10-14 days pyelonephritis

  15. Ecoli • Urinary tract infections • Catheterised (not exclusively) • Preventable? • Peak in summer • The role of primary care • Symptoms

  16. ESBLs • Extended spectrum betalactamases • Resistant to coamox, amox, cephalosporins, piptazo • Usually associated resistance to quinolones and gentamycin • Usually urines, many in the community • What’s left: Temocilin, fosfomycin, meropenem, ertapenem

  17. Carbapenemase producing enterobacteria • CPE • Urines, pneumonia, wounds and ulcers • Travel to South Europe, India… and Manchester • What’s left: fosfomycin, colystin…or nothing!

  18. Respiratory: challenges • Existing pathology: COPD, bronchiectasis • Decreased cough reflex • Dysphagia, stroke • The trouble with CXR!

  19. Respiratory • Seasonal illness • Influenza • Parainfluenza • RSV • Non seasonal illness • Pneumococcal • Haemophilus • Aspiration pneumonia • Legionella-not just for travellers!

  20. GI • Norovirus • Not just winter vomiting! • Pre-admission management • PEG • Cryptosporidium, Salmonella, Campylobacter • Listeria • Hepatitis (A, B and E, also C)

  21. Cdiff • Colonisation increases with age • PPIs and antibiotics predispose • NG feeding, GI pathology, malnutrition • Recurrence is common • Length of stay

  22. HCAI • MRSA, MSSA, Cdiff and Ecoli • Other: ESBLs,Carbapenemases • Contact with healthcare and interventions • >50% HCAI in >65yo

  23. MRSA, MSSA • 30% population colonised with Staph aureus • Skin and soft tissue • Pneumonia • Endocarditis • 20-30% mortality risk • Decolonisation difficult in elderly population

  24. Vaccine preventable • Influenza • Pneumococcus • Varicella • Meningococcus • Haemophilus • Pertussis

  25. Summary • Predisposing factors • Care beyond hospitals • HCAIs and resistance • Education • Prevention

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