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Infectious Disease Clinics of North America

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https://www.readbyqxmd.com/read/29079162/aging-has-unique-effects-on-the-risks-presentation-diagnosis-treatment-and-prognosis-of-infectious-diseases
#1
EDITORIAL
Robin L P Jump, David H Canaday
No abstract text is available yet for this article.
December 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/29079161/hepatitis-c-virus-infection-in-the-older-patient
#2
REVIEW
Michael Reid, Jennifer C Price, Phyllis C Tien
Hepatitis C virus (HCV) is the most common blood-borne infection in the United States and is of concern in older adults. HCV infection is associated with not only hepatic but also extrahepatic comorbidities common to the aging patient including diabetes, kidney and cardiovascular diseases, and neurocognitive impairment. The effect of direct-acting antiviral agents to treat HCV on these outcomes is limited. This article summarizes the literature regarding the epidemiology and natural history of HCV infection; the impact of age on clinical outcomes in HCV-infected persons; and current knowledge regarding safety and efficacy of HCV treatment regimens in the older patient...
December 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/29079160/herpes-zoster-in-the-older-adult
#3
REVIEW
Amrita R John, David H Canaday
Herpes zoster (HZ) is the result of reactivation of latent varicella zoster virus (VZV) and occurs most frequently in older adults. Classically, HZ presents as a unilateral, selflimited, dermatomal rash. Postherpetic neuralgia (PHN) is a common sequela, presenting as severe pain that persists after the rash has resolved. In the elderly, PHN can be debilitating and requires a prompt diagnosis, treatment with antivirals, and adequate pain control. A longer-term pain management strategy is required if PHN occurs...
December 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/29079159/respiratory-syncytial-virus-and-other-noninfluenza-respiratory-viruses-in-older-adults
#4
REVIEW
Fumihiro Kodama, David A Nace, Robin L P Jump
Respiratory viral infections may cause serious complications for older adults, including residents of long-term care facilities (LTCFs). Although influenza is the most common cause of viral respiratory infections among older adults, several other respiratory viruses also cause significant morbidity and mortality, most notably respiratory syncytial virus. Other noninfluenza respiratory viral pathogens include human metapneumovirus, parainfluenza virus, rhinovirus, coronavirus, and adenovirus. All of these may cause outbreaks among LTCF residents...
December 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/29079158/clostridium-difficile-in-older-adults
#5
REVIEW
Curtis J Donskey
Recent increases in the incidence of Clostridium difficile infection (CDI) have been observed in all age groups, but the elderly have been disproportionately affected and long-term care facilities (LTCFs) have borne a significant proportion of the increasing burden. Recurrences are common in older adults and may have significant adverse effects on quality of life. Ensuring appropriate diagnostic testing and management is challenging for older adults in the community and in LTCFs. This review focuses on current concepts related to the epidemiology, diagnosis, and management of CDI in older adults...
December 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/29079157/sepsis-in-older-adults
#6
REVIEW
Theresa A Rowe, June M McKoy
Sepsis disproportionally affects older adults with more than 60% of sepsis diagnoses attributed to adults aged 65 years and older. Identifying, diagnosing, and treating sepsis in older individuals remain a challenge for clinicians, and few studies focus specifically on older adults with multiple medical comorbidities. Principles guiding management of sepsis for older adults are generally the same as in younger adults; however, unique considerations particularly pertinent to the care older adults include antimicrobial selection and dosing, delirium management, and goals of care discussions...
December 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/29079156/septic-arthritis-and-prosthetic-joint-infections-in-older-adults
#7
REVIEW
Rajeshwari Nair, Marin L Schweizer, Namrata Singh
Older adults are at increased risk for septic arthritis and prosthetic joint infections (PJI), owing at least in part to comorbid conditions and frailty. An increasing number of older adults undergo total joint arthroplasty to improve their quality of life. Infections in older adults differ from younger populations by the causative organisms, a great proportion of which are Staphylococcal infections. Targeting important modifiable and nonmodifiable risk factors may prevent or reduce the burden of joint infections in older adults...
December 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/29079155/urinary-tract-infection-and-asymptomatic-bacteriuria-in-older-adults
#8
REVIEW
Nicolas W Cortes-Penfield, Barbara W Trautner, Robin L P Jump
Urinary tract infections (UTIs) are a significant cause of morbidity among older adults. However, antibiotic prescriptions for clinically suspected UTIs are often inappropriate. Health care providers frequently struggle to differentiate UTI from asymptomatic bacteriuria, particularly in patients presenting with nonspecific symptoms. Patients with baseline cognitive impairments that limit history-taking can be particularly challenging. This article reviews the epidemiology and pathogenesis of UTI in older adults...
December 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/29079154/breaking-the-chain-of-infection-in-older-adults-a-review-of-risk-factors-and-strategies-for-preventing-device-related-infections
#9
REVIEW
Gregory Schrank, Westyn Branch-Elliman
Device-related infections (DRIs) are a significant cause of morbidity and mortality among older adults. Indwelling devices (urinary catheters, percutaneous feeding tubes, and central venous catheters) are frequently used in this vulnerable population. Indwelling devices provide a portal of entry for pathogenic organisms to invade a susceptible host and cause infection and are an important target for infection prevention and antimicrobial stewardship efforts. Within the "Chain of Infection" that leads to DRIs in older adults, multiple opportunities exist to implement interventions that "break the links" and reduce colonization with multidrug-resistant organisms, reduce infections, and improve antimicrobial use...
December 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/29079153/antimicrobial-use-at-the-end-of-life
#10
REVIEW
Adam Baghban, Manisha Juthani-Mehta
At least one-third of patients at the end of life (EOL) receive interventions that are without benefit, and a similar proportion of patients die in the intensive care unit. Here, the authors discuss the role of antimicrobials in patients at the EOL, including the patient populations and scenarios in which antimicrobials may or may not have benefit. They also review adverse outcomes associated with antimicrobial use at the EOL, including societal harms. Finally, an algorithm to aid management of suspected infections at the EOL is proposed...
December 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/29079152/antibiotic-stewardship-in-nursing-facilities
#11
REVIEW
Miranda McElligott, Grace Welham, Aurora Pop-Vicas, Lyndsay Taylor, Christopher J Crnich
Misuse and overuse of antibiotic therapy is a frequent cause of resident harm in nursing facilities. As a result, newly released policy and regulatory initiatives will require antibiotic stewardship programs (ASPs) in nursing facilities. Although implementing ASPs can be challenging, improving the quality of antibiotic prescribing is achievable in this setting. The authors review the determinants of antibiotic prescribing in nursing facilities, strategies to improve antibiotic prescribing in this setting, current status of ASPs in nursing facilities, and steps that facilities can take to enhance existing ASP structure and process...
December 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/29079151/antimicrobial-pharmacokinetics-and-pharmacodynamics-in-older-adults
#12
REVIEW
John M Benson
Antimicrobial use in older adults requires working knowledge of the pharmacokinetics and pharmacodynamics of these drugs, and the alterations known to occur with these models as patients age. A summary of pharmacokinetic principles relevant to antimicrobials and an overview of published medical literature describing pharmacokinetic changes known to correlate with age are presented. Pharmacodynamic models that apply to antibacterial agents are reviewed, as are likely effects of aging on these models. The understanding of how older adults respond in terms of efficacy and toxicity is increasing but limited...
December 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/29079150/influence-of-aging-and-environment-on-presentation-of-infection-in-older-adults
#13
REVIEW
Nadim G El Chakhtoura, Robert A Bonomo, Robin L P Jump
In older adults, pathophysiologic, clinical, and environmental factors all affect the presentation of infections. We explore how age-related changes influence the manifestation and evaluation of infections in this population. Specific topics include immunosenescence, age-related organ-specific physiologic changes, and frailty. We also describe clinical factors influencing infection risk and presentation in older adults, including temperature regulation, cognitive decline, and malnutrition. Finally, we discuss the influence of the setting in which older adults reside on the clinical evaluation of infection...
December 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28916385/bacterial-pneumonia-in-older-adults
#14
REVIEW
Oryan Henig, Keith S Kaye
The incidence of pneumonia increases with age, and is particularly high in patients who reside in long-term care facilities (LTCFs). Mortality rates for pneumonia in older adults are high and have not decreased in the last decade. Atypical symptoms and exacerbation of underlying illnesses should trigger clinical suspicion of pneumonia. Risk factors for multidrug-resistant organisms are more common in older adults, particularly among LTCF residents, and should be considered when making empiric treatment decisions...
December 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28916384/human-immunodeficiency-virus-and-aging-in-the-era-of-effective-antiretroviral-therapy
#15
REVIEW
Puja Van Epps, Robert C Kalayjian
Persons living with HIV (PLWH) have accentuated risks for age-associated comorbidities. Compared to the general population, PLWH have a 2-fold higher risk of cardiovascular disease, a 3-fold increased risk of fracture, and a risk of kidney disease that is comparable to that in diabetes. Some comorbidities may present at younger ages than among the general population, suggesting the possibility of accelerated aging with HIV infection.
December 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28911830/norovirus-infection-in-older-adults-epidemiology-risk-factors-and-opportunities-for-prevention-and-control
#16
REVIEW
Cristina V Cardemil, Umesh D Parashar, Aron J Hall
Norovirus is the leading cause of acute gastroenteritis. In older adults, it is responsible for an estimated 3.7 million illnesses; 320,000 outpatient visits; 69,000 emergency department visits; 39,000 hospitalizations; and 960 deaths annually in the United States. Older adults are particularly at risk for severe outcomes, including prolonged symptoms and death. Long-term care facilities and hospitals are the most common settings for norovirus outbreaks in developed countries. Diagnostic platforms are expanding...
December 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28911829/influenza-in-older-adults
#17
REVIEW
H Keipp Talbot
Annually, influenza viruses cause significant disease in older adults, varying with the virulence of the circulating strain, prior exposure to circulating strain, and influenza vaccine effectiveness. Older adults often present atypically (eg, without fever) and with complications of influenza infection such as chronic obstructive pulmonary disease and congestive heart failure exacerbations. Prevention methods include antiviral medications and vaccines. Current influenza vaccines have moderate effectiveness for the prevention of hospitalization, but newer more immunogenic vaccines designed for adults 65 years of age and older have been licensed...
December 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28779835/on-the-interface-of-infectious-diseases-and-critical-care-medicine
#18
EDITORIAL
Naomi P O'Grady, Sameer S Kadri
No abstract text is available yet for this article.
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28779834/inhaled-antibiotics-for-ventilator-associated-infections
#19
REVIEW
Lucy B Palmer
Multidrug-resistant organisms are creating a challenge for physicians treating the critically ill. As new antibiotics lag behind the emergence of worsening resistance, intensivists in countries with high rates of extensively drug-resistant bacteria are turning to inhaled antibiotics as adjunctive therapy. These drugs can provide high concentrations of drug in the lung that could not be achieved with intravenous antibiotics without significant systemic toxicity. This article summarizes current evidence describing the use of inhaled antibiotics for the treatment of bacterial ventilator-associated pneumonia and ventilator-associated tracheobronchitis...
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28779833/high-containment-pathogen-preparation-in-the-intensive-care-unit
#20
REVIEW
Brian T Garibaldi, Daniel S Chertow
The recent Ebola virus disease outbreak highlighted the need to build national and worldwide capacity to provide care for patients with highly infectious diseases. Specialized biocontainment units were successful in treating several critically ill patients with Ebola virus disease both in the United States and Europe. Several key principles underlie the care of critically ill patients in a high-containment environment. Environmental factors, staffing, equipment, training, laboratory testing, procedures, and waste management each present unique challenges...
September 2017: Infectious Disease Clinics of North America
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