Chapter 15 : Infections in Long-Term Care Facilities

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Chronic and comorbid conditions can lead to functional decline, an inability to live independently, and the need for residence in a long-term care facility (LTCF). Older individuals have a unique predisposition to developing infections compared to younger adults because of a number of risk factors. First, age-associated impairments in immunity make older persons more vulnerable to infectious diseases. Second, older adults often have a constellation of chronic and comorbid diseases (e.g., diabetes mellitus and chronic obstructive pulmonary disease) that place them at increased risk for common community-acquired infections such as pneumonia and urinary tract infection (UTI). Third, because of the functional limitations associated with advanced age, group living arrangements, and instrumentation of prosthetic, older individuals are at increased risk for aspiration pneumonia, outbreaks of gastroenteritis (e.g., norovirus), recurrent UTI, and prosthetic device infections. It is evident from the growing aging population worldwide, with increased residence in LTCFs, that infections in LTCF residents are an emerging infectious disease entity worldwide. Although rates of resistance to penicillin and cephalosporins appear to be stable, macrolide resistance continues to increase. Fluoroquinolone use predicts an increased risk of infection with fluoroquinolone-resistant pneumococci. Residence in LTCFs is growing with the aging global population. Infections in nursing home residents are prevalent and important causes of morbidity and mortality. Although not classically thought of as emerging infectious diseases, these common infections are increasing in the communal setting of long-term care and need to be considered in this way.

Citation: Juthani-Mehta M, Quagliarello V. 2010. Infections in Long-Term Care Facilities, p 287-303. In Scheld W, Grayson M, Hughes J (ed), Emerging Infections 9. ASM Press, Washington, DC. doi: 10.1128/9781555816803.ch15
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Figure 1.

Diagnostic algorithm for ordering urine cultures for nursing home residents ( ).

Citation: Juthani-Mehta M, Quagliarello V. 2010. Infections in Long-Term Care Facilities, p 287-303. In Scheld W, Grayson M, Hughes J (ed), Emerging Infections 9. ASM Press, Washington, DC. doi: 10.1128/9781555816803.ch15
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Figure 2.

Treatment algorithm for prescribing antimicrobials to nursing home residents ( ).

Citation: Juthani-Mehta M, Quagliarello V. 2010. Infections in Long-Term Care Facilities, p 287-303. In Scheld W, Grayson M, Hughes J (ed), Emerging Infections 9. ASM Press, Washington, DC. doi: 10.1128/9781555816803.ch15
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Generic image for table
Table 1.

Recommended antimicrobial therapy for specific pathogens for pneumonia ( )

Citation: Juthani-Mehta M, Quagliarello V. 2010. Infections in Long-Term Care Facilities, p 287-303. In Scheld W, Grayson M, Hughes J (ed), Emerging Infections 9. ASM Press, Washington, DC. doi: 10.1128/9781555816803.ch15

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