Pitfalls in the diagnosis and therapy of infections in elderly patients--a mini-review.

Extended life expectancy is paralleled by an increasing number of patients older than 65 years suffering from severe infections. Infections in this group of patients are generally more severe and associated with an increased risk of death. This is related to several factors which are discussed in this review. Specifically, immunosenescence and an atypical presentation of infection-associated symptoms with a subsequent delay of diagnosis and initiation of antimicrobial treatment are cornerstones in this dilemma. In addition, comorbidities and comedications, a changing spectrum of pathogens with a higher percentage of multiresistant pathogens, and more importantly, an altered pharmacokinetics of antimicrobial drugs are further contributing factors to the adverse outcome of infections in elderly subjects. Infections in the elderly demand special attention in terms of diagnosis and treatment. As the mortality rates are high, special emphasis must be put on preventive measures including effective vaccination strategies and establishment of hygiene standards to prevent transmission of multiresistant pathogens among elderly patients, both in health care centers and nursing homes.