Evaluation of geriatric infections

Purpose: It is known that the population aged 65 years and over will increase rapidly in the next 25 years. Therefore, the majority of patients with serious or life-threatening infections will be geriatric patients (1). Geriatric patients have unique characteristics and the diagnosis and treatment of infectious diseases in this patient population may be difficult (2). Instead of classical signs of infection, atypical findings are frequently observed in geriatric patients. Clinicians dealing with geriatric patients should be aware of these non-classical manifestations of infections in this age group (3). The results obtained in our study will contribute to the development of diagnostic algorithms in geriatric patients with suspected infection and will help to reach a faster and more accurate diagnosis. Materials and Methods: In this study, inpatient epicrises of infectious diseases and clinical microbiology service inpatients between 01.01.2019-31.12.2023 were retrospectively analyzed from the electronic data system of Karadeniz Technical University Farabi Hospital. Patients over 65 years of age and defined as having an infectious disease were included in the study. Results: This study included 822 patients aged 65 years and older. 48.3% of the patients were female and 51.7% were male. 51.8% of the patients were 65-74 years old, 32.4% were 75-84 years old, and 15.8% were 85 years and older. The most common symptom was fever (34.5%). At least one comorbidity/condition was present in 90.3% of all patients. The most common comorbidities were HT (61.7%), DM (35.2%) and coronary artery disease (19.7%). Physical examination revealed altered consciousness in 14.5%, fever in 3.8%, tachycardia in 7.9%, bradycardia in 1.8%, hypertension in 10.1%, hypotension in 3.5%, tachypnea in 7.5%. In 93.6% of the cases CRP and 27.6 % PCT were above normal. Leukocytosis was present in 30.7% of the cases. It was found that 31% of all cases were followed up for pneumonia, 21% for urinary tract infection and 10.2% for skin and soft tissue infection. The most common Gram-negative bacteria were E. coli (40.4%), K. pneumoniae (23%) and P. aureginosa (12.8%). The most common Gram-positive bacteria were S. aureus (36.4%) and E. faecalis (22.7%). 32.5% of S. aureus strains were methicillin resistant. The most used antibiotics were ceftriaxone, ertapenem, meropenem and cefazolin, respectively. Antibiotic use in the last 6 months was observed in 41% of the cases. The most used antibiotic groups were cephalosporins and quinolones. 13.7% of the cases were transferred to intensive care unit. The mean duration of hospitalization was 10.3±7.7. While 80.4% of all patients survived, 12.4% died. Conclusion: Our study reveals the clinical features and diagnostic difficulties of infections frequently seen in the geriatric population. The results show that geriatric infections often present with atypical findings (altered consciousness, weakness, loss of appetite) instead of classical symptoms. The limited sensitivity of acute phase reactants makes the diagnosis of geriatric infections even more difficult. Therefore, in case of suspicion of infection in geriatric patients, a detailed anamnesis, a thorough physical examination and a careful laboratory evaluation should be performed. The results of our study will provide important clinical guidance for the early diagnosis and appropriate treatment of geriatric infections.