Preventing healthcare-related infections among older adults: a focus on cross-transmission of antibiotic-resistant bacteria

ABSTRACT

Introduction

Older individuals (i.e. age ≥65 years) are at increased risk for development of infections including those due to antimicrobial-resistant bacteria, and transmission may occur between institutional and community settings.

Areas covered

This article reviews infections in older individuals with a specific focus on healthcare-related and antimicrobial resistant infections. A structured narrative review was performed to identify articles published in English since 2010. Themes included defining the scope of the problem, establishing characteristics of older individuals that impact the burden of resistant infections, and interventions aimed at minimizing their impact.

Expert opinion

Older individuals suffer a high burden of illness related to antimicrobial resistant infections. Individuals with chronic illnesses, frailty, and residents of nursing homes are at highest risk. Clinical trials have shown that antimicrobial stewardship interventions may reduce antibiotic use in nursing homes without compromising safety. Antimicrobial resistant bacteria are prevalent among nursing home residents, and bundled infection prevention and control interventions can reduce their transmission. Transmission of antimicrobial resistant bacteria occurs among older adults across hospital and institutional settings, which may further spread to the community. The burden of infections in older adults is expected to increase in the coming years and represents a healthcare and research priority.

KEYWORDS:

• Aged
• 65 and older
• bacteremia
• drug resistance
• nursing home
• infection control

Article highlights

• Antimicrobial stewardship interventions have been shown to reduce antibiotic use in nursing homes without compromising safety.

• Bundled infection prevention and control interventions have been shown to reduce the impact of antimicrobial resistant bacteria in nursing home residents.

• A population-based approach to investigating and managing infections in older adults is recommended.

• Nursing homes should not be compartmentalied for infection prevention and control purposes but rather considered as a continuum interacting with the community and hospitals.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.