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Elderly Patients

As they age, elderly patients become more susceptible to infection and diagnostic uncertainty. This can lead to increased levels of antibiotic exposure.

Greater use of antibiotics limits their effectiveness and can result in antibiotic resistance, especially among patients older than 65.

The challenge of managing infection in elderly patients

Compared to younger adults, diagnostic uncertainty is much more pronounced when assessing elderly patients as infections in older patients often present atypically.1

This is associated with:

Increased length of stay

Higher hospital mortality

Increased hospital costs

Decrease diagnostic uncertainty and improve antibiotic decision making by aid of PCT.

B·R·A·H·M·S PCT to improve antibiotic exposure
Download the summary leaflet of the opinion paper “Biomarkers for stratification and antibiotic stewardship in elderly patients” prepared by multi-disciplinary and recognized European clinical experts
B·R·A·H·M·S PCT to improve antibiotic exposure
Download the summary leaflet of the opinion paper “Biomarkers for stratification and antibiotic stewardship in elderly patients” prepared by multi-disciplinary and recognized European clinical experts

Procalcitonin (PCT) has been demonstrated in a range of interventional, randomized, controlled trials to:

  • facilitate effective and safe antibiotic stewardship (ABS)
  • reduce antibiotic exposure without compromising patients' outcomes5,6,7,8
Higher susceptibility to infection with increasing age and diagnostic uncertainty contribute to higher antibiotic exposure in elderly patients.2

High antibiotic use is also reflected in the rise of antibiotic resistance observed in elderly patients compared to patients younger than 65 years.3,4

The impact of PCT-aided antibiotic stewardship (ABS) on antibiotic exposure and mortality was similar in elderly patients as compared to younger adults independent of clinical diagnosis and place of treatment.5

30-day mortality

  • No adverse impact: OR 0.90 (95% CI 0.81-1.00) for PCT approach vs. standard of care, respectively.
  • No significant difference between age-specific subgroups.

The highest reduction of antibiotic exposure by a PCT-aided approach was achieved for:

patients with pneumonia (-3.71 days) or other LRTI (-2.32 days

patients with low-severity disease/low outcome risk (SOFA 0-6) (-2.43 days)

patients treated on the ward (or in primary care) (-3.02 days)

Webinar | Managing infections in the elderly and potential role of biomarkers
Hear from Prof. Dr. Marco Falcone and Prof. Dr. Philipp Schuetz from ESCIM LIVES 2021
Webinar | Managing infections in the elderly and potential role of biomarkers
Hear from Prof. Dr. Marco Falcone and Prof. Dr. Philipp Schuetz from ESCIM LIVES 2021

Sepsis in the Elderly

Sepsis is a life-threatening medical emergency that affects people of all ages. However, older adults, particularly those who have health issues, are disproportionally affected. Early detection and treatment are essential for survival. PCT testing adds key information to the clinical assessment on the presence, course, and severity of sepsis, allowing clinicians to improve antibiotic decision making.

Sepsis is especially dangerous for elderly patients.

People over 65 are 13 times more likely to be hospitalized with sepsis10-12 than adults younger than 65.

Mortality rates for elderly patients with severe sepsis and septic shock are around 50–60%.9-12 These high death rates occur because the elderly often experience co-morbidities, frequent and extended hospitalizations, weakened immune systems, functional limitations, and general effects of aging like thinning skin, frailty, and a sedentary lifestyle.9

Making a timely and accurate diagnosis is essential 

Diagnosis of infection is often difficult and delayed.13 For example, the first symptom of a UTI, a leading cause of infection, is typically confusion and disorientation, making it hard for the patient to describe his or her symptoms. In addition, the presentation of symptoms can be ambiguous or atypical. Moreover, elderly patients may not exhibit fever or other clinical signs of infection or inflammation seen in younger patients, even though seniors are at higher mortality risk.

Additionally, the bladder is often colonized in many elderly people leading to false positive results of the urinalysis that show colonization and not infection. This leads to an over prescription of antibiotics in this patient population.14

The decline in immune function often observed in elderly patients15-17 can result in atypical and frequently subtle (e.g., mild fever or even apyrexia) clinical presentations of bacteremia,15,16,18-20 further increasing the risk of under diagnosis and subsequent delays in the treatment of sepsis.

Given these challenges to diagnosis, and the vulnerability of the geriatric population to infection, having a diagnostic test with high specificity and predictive value is essential. Procalcitonin (PCT) can meet this need. With PCT testing, physicians gain timely information specific to systemic bacterial infection, including its presence, course, and severity.21

 

PCT is sensitive and specific

One meta-analysis of four studies (760 patients, aged 65 years and older) evaluated the accuracy of procalcitonin in diagnosing systemic bacterial infections in elderly patients.19 It was found that procalcitonin is both specific and sensitive in the diagnosis of severe bacterial infection in elderly patients. As shown in randomized controlled trials, very elderly patients can benefit from the use of PCT as a means of lowering antibiotic exposure. While kidney function in many older patients may be impaired, which can affect biomarker kinetics, there is no evidence that it impacts the usefulness of PCT as a diagnostic tool. As always, test results should be interpreted in the context of clinical findings.

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References
  1. Becket et al., Clin Microbiol Infect 2015; 21(1): 3–9, https://doi.org/10.1016/j.cmi.2014.08.018.
  2. Chui et al., Drug Safety 2020; 43: 595–606, https://doi.org/10.1007/s40264-020-00920-9.
  3. Giarratano et al., Clin Interv Aging 2018; 13: 657–667, https://doi.org/10.2147/cia.s133640.
  4. Nguyen et al., PLoS ONE 14(10): e0223409, https://doi.org/10.1371/journal.pone.0223409.
  5. de Jong et al., Lancet Infect Dis 2016; 16(7): 819–827, https://doi.org/10.1016/s1473-3099(16)00053-0.
  6. Kyriazopoulou et al., Am J Respir Crit Care Med 2021; 203(2): 202–210, https://doi.org/10.1164/rccm.202004-1201oc.
  7. Schuetz et al., JAMA 2009; 302(10): 1059–1066, https://doi.org/10.1001/jama.2009.1297.
  8. Schuetz et al., Lancet Infect Dis 2018; 18(1): 95–107, https://doi.org/10.1016/s1473-3099(17)30592-3.
  9. Nasa P, Juneja D, Singh O, Dang R, Arora V. Severe sepsis and its impact on outcome in elderly and very elderly patients admitted in intensive care unit. J Intensive Care Med. 2012 May;27(3):179-83.
  10. Hall MJ, Williams SN, DeFrances CJ, Golosinskiy A. Inpatient care for septicemia or sepsis: a challenge for patients and hospitals. NCHS data brief. 2011;(62): 1–8.
  11. Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. Crit Care Med. 2006;34:15–21.
  12. Vosylius S, Sipylaite J, Ivaskevicius J. Determinants of outcome in elderly patients admitted to the intensive care unit. Age Ageing. 2005;34:157–162.
  13. Girard TD, Ely EW. Bacteremia and sepsis in older adults. Clin Geriatr Med. 2007;23:633–47.
  14. Pallin DJ, Ronan C, Montazeri K, Wai K, Gold A, Parmar S, et al. Urinalysis in acute care of adults: Pitfalls in testing and interpreting results. Open Forum Infect Dis. 2014 Mar 1 (Vol. 1, No. 1). Oxford University Press.
  15. Ackermann RJ, Monroe PW. Bacteremic urinary tract infection in older people. J Am Geriatr Soc. 1996 Aug;44(8):927-33.
  16. Lee CC, Chang IJ, Lai YC, Chen SY, Chen SC. Epidemiology and prognostic determinants of patients with bacteremic cholecystitis or cholangitis. Am J Gastroenterol. 2007 Mar 1;102(3):563-9.
  17. Gutierrez F, Masia M. Improving outcomes of elderly patients with community-acquired pneumonia. Drugs Aging 2008;25:585-610.
  18. Van Duin D. Diagnostic challenges and opportunities in older adults with infectious diseases. Clin Infect Dis. 2012;54:973–8.
  19. Lee SH, Chan RC, Wu JY, et al. Diagnostic value of procalcitonin for bacterial infection in elderly patients - A systemic review and meta-analysis. Int J Clin Pract. 2013;67:1350-1357.
  20. Fernández-Sabé N, Carratalà J, Rosón B, Dorca J, Verdaguer R, Manresa F, et al. Community-acquired pneumonia in very elderly patients: Causative organisms, clinical characteristics, and outcomes. Medicine. 2003 May 1;82(3):159-69.
  21. Karzai W, Oberhoffer M, Meier-Hellmann A, Reinhart K. Procalcitonin—A new indicator of the systemic response to severe infections. Infection. 1997 Nov 1;25(6):329-34.
  22. Gómez-Cerquera JM, Daroca-Pérez R, Baeza-Trinidad R, Casañas-Martinez M, Mosquera-Lozano JD, Ramalle-Gómara E. Validity of procalcitonin for the diagnosis of bacterial infection in elderly patients. Enferm Infecc Microbiol Clin. 2015 Oct;33(8):521-4.
  23. Fuentes E, Fuentes M, Alarcon M, Palomo I. Immune System Dysfunction in the Elderly. An Acad Bras Cienc. 2017;89(1):285-299.
  24. Guertler C, Wirz B, Christ-Crain M, Zimmerli W, Mueller B, Schuetz P. Inflammatory responses predict long-term mortality risk in community-acquired pneumonia. Eur Respir J. 2011;37(6):1439-1446.  
  25. Schuetz P, Christ-Crain M, Muller B. Biomarkers to improve diagnostic and prognostic accuracy in systemic infections. Current opinion in critical care. 2007;13(5):578-585. 
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