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Managing Infectious Disease in the Critically Ill Elderly Patient

  • Kaushik MukherjeeEmail author
  • Sigrid K. Burruss
  • Steven E. Brooks
  • Addison K. May
Surgical Care (F Luchette and R Gonzalez, Section Editors)
  • 7 Downloads
Part of the following topical collections:
  1. Topical Collection on Surgical Care

Abstract

Purpose of the Review

Infections and subsequent sepsis are an increasing cause of hospital admission and critical illness in the elderly population. The risk factors that predispose elderly patients to infections, such as comorbidities and frailty, also contribute to prolonged recovery times and subsequent mortality.

Recent Findings

Elderly patients may present with atypical symptoms such as delirium and remain afebrile thus delaying the diagnosis of infections. White blood cell count is not as useful in the diagnosis of infection as other biomarkers such as procalcitonin. Once an infection has begun, the elderly patient has less physiologic cardiac and respiratory reserve and develops end organ damage more rapidly. Frailty itself is strongly associated with high rates of first time sepsis. Mortality risk from sepsis clearly increases with age. Appropriate antibiotics and source control are necessary components of sepsis management as is early fluid resuscitation. Fluid resuscitation must be performed judiciously with appropriate endpoints utilizing bedside cardiac ultrasound and IVC collapsibility to avoid fluid overload. Acute kidney injury (AKI) occurs in 1/3–2/3 of elderly septic patients and increases mortality. AKI is potentially preventable with appropriate and timely fluid resuscitation and avoiding nephrotoxic medications including loading doses of vancomycin, limiting aminoglycoside exposure to < 3 days, and minimizing colistin use. Source control within 12 h when appropriate improves outcome. Specific infections, including Clostridium difficile, community-acquired pneumonia, and urinary tract infection, pose unique challenges in the elderly. Early goals-of-care discussions emphasizing potential complications and undesirable outcomes must be discussed when caring for critically ill elderly patients.

Summary

Early recognition of sepsis via identification of atypical signs and symptoms in elderly patients is critical. This allows for timely and appropriate therapy to decrease the incidence of end organ damage and mortality in high-risk elderly patients.

Keywords

Elderly Geriatric Critical illness Septic shock Acute kidney injury Frailty 

Notes

Compliance with Ethical Standards

Conflict of Interest

Kaushik Mukherjee, Sigrid K. Burruss, Steven E. Brooks, and Addison K. May each declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kaushik Mukherjee
    • 1
    Email author
  • Sigrid K. Burruss
    • 1
  • Steven E. Brooks
    • 2
  • Addison K. May
    • 3
  1. 1.Loma Linda University Medical CenterLoma LindaUSA
  2. 2.Texas Tech University Health Sciences CenterLubbockUSA
  3. 3.Carolinas Medical CenterCharlotteUSA

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