Managing infective endocarditis in the elderly: new issues for an old disease

Emmanuel Forestier,1 Thibaut Fraisse,2 Claire Roubaud-Baudron,3 Christine Selton-Suty,4 Leonardo Pagani5 1Infectious Diseases Department, Centre Hospitalier Métropole Savoie, Chambéry, France; 2Acute Geriatric Department, Centre Hospitalier, Alès, France; 3Geriatric...

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Autores principales:	Forestier E, Fraisse T, Roubaud-Baudron C, Selton-Suty C, Pagani L
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	Infective endocarditis elderly antibiotic therapy cardiac surgery frailty Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/5ddb40d9171c46198ef7d6aab3d34dbc
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spelling	oai:doaj.org-article:5ddb40d9171c46198ef7d6aab3d34dbc2021-12-02T04:57:59ZManaging infective endocarditis in the elderly: new issues for an old disease1178-1998https://doaj.org/article/5ddb40d9171c46198ef7d6aab3d34dbc2016-09-01T00:00:00Zhttps://www.dovepress.com/managing-infective-endocarditis-in-the-elderly-new-issues-for-an-old-d-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Emmanuel Forestier,1 Thibaut Fraisse,2 Claire Roubaud-Baudron,3 Christine Selton-Suty,4 Leonardo Pagani5 1Infectious Diseases Department, Centre Hospitalier Métropole Savoie, Chambéry, France; 2Acute Geriatric Department, Centre Hospitalier, Alès, France; 3Geriatric Department, University Hospital, Bordeaux, France; 4Department of Cardiology, University Hospital, Nancy, France; 5Infectious Diseases Department, Centre Hospitalier Annecy-Genevois, Annecy, France Abstract: The incidence of infective endocarditis (IE) rises in industrialized countries. Older people are more affected by this severe disease, notably because of the increasing number of invasive procedures and intracardiac devices implanted in these patients. Peculiar clinical and echocardiographic features, microorganisms involved, and prognosis of IE in elderly have been underlined in several studies. Additionally, elderly population appears quite heterogeneous, from healthy people without past medical history to patients with multiple diseases or who are even bedridden. However, the management of IE in this population has been poorly explored, and international guidelines do not recommend adapting the therapeutic strategy to the patient’s functional status and comorbidities. Yet, if IE should be treated according to current recommendations in the healthiest patients, concerns may rise for older patients who suffer from several chronic diseases, especially renal failure, and are on polypharmacy. Treating frailest patients with high-dose intravenous antibiotics during a prolonged hospital stay as recommended for younger patients could also expose them to functional decline and toxic effect. Likewise, the place of surgery according to the aging characteristics of each patient is unclear. The aim of this article is to review the recent data on epidemiology of IE and its peculiarities in the elderly. Then, its management and various therapeutic approaches that can be considered according to and beyond guidelines depending on patient comorbidities and frailty are discussed. Keywords: infective endocarditis, elderly, antibiotic therapy, cardiac surgery, frailtyForestier EFraisse TRoubaud-Baudron CSelton-Suty CPagani LDove Medical PressarticleInfective endocarditiselderlyantibiotic therapycardiac surgeryfrailtyGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 11, Pp 1199-1206 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	Infective endocarditis elderly antibiotic therapy cardiac surgery frailty Geriatrics RC952-954.6
spellingShingle	Infective endocarditis elderly antibiotic therapy cardiac surgery frailty Geriatrics RC952-954.6 Forestier E Fraisse T Roubaud-Baudron C Selton-Suty C Pagani L Managing infective endocarditis in the elderly: new issues for an old disease
description	Emmanuel Forestier,1 Thibaut Fraisse,2 Claire Roubaud-Baudron,3 Christine Selton-Suty,4 Leonardo Pagani5 1Infectious Diseases Department, Centre Hospitalier Métropole Savoie, Chambéry, France; 2Acute Geriatric Department, Centre Hospitalier, Alès, France; 3Geriatric Department, University Hospital, Bordeaux, France; 4Department of Cardiology, University Hospital, Nancy, France; 5Infectious Diseases Department, Centre Hospitalier Annecy-Genevois, Annecy, France Abstract: The incidence of infective endocarditis (IE) rises in industrialized countries. Older people are more affected by this severe disease, notably because of the increasing number of invasive procedures and intracardiac devices implanted in these patients. Peculiar clinical and echocardiographic features, microorganisms involved, and prognosis of IE in elderly have been underlined in several studies. Additionally, elderly population appears quite heterogeneous, from healthy people without past medical history to patients with multiple diseases or who are even bedridden. However, the management of IE in this population has been poorly explored, and international guidelines do not recommend adapting the therapeutic strategy to the patient’s functional status and comorbidities. Yet, if IE should be treated according to current recommendations in the healthiest patients, concerns may rise for older patients who suffer from several chronic diseases, especially renal failure, and are on polypharmacy. Treating frailest patients with high-dose intravenous antibiotics during a prolonged hospital stay as recommended for younger patients could also expose them to functional decline and toxic effect. Likewise, the place of surgery according to the aging characteristics of each patient is unclear. The aim of this article is to review the recent data on epidemiology of IE and its peculiarities in the elderly. Then, its management and various therapeutic approaches that can be considered according to and beyond guidelines depending on patient comorbidities and frailty are discussed. Keywords: infective endocarditis, elderly, antibiotic therapy, cardiac surgery, frailty
format	article
author	Forestier E Fraisse T Roubaud-Baudron C Selton-Suty C Pagani L
author_facet	Forestier E Fraisse T Roubaud-Baudron C Selton-Suty C Pagani L
author_sort	Forestier E
title	Managing infective endocarditis in the elderly: new issues for an old disease
title_short	Managing infective endocarditis in the elderly: new issues for an old disease
title_full	Managing infective endocarditis in the elderly: new issues for an old disease
title_fullStr	Managing infective endocarditis in the elderly: new issues for an old disease
title_full_unstemmed	Managing infective endocarditis in the elderly: new issues for an old disease
title_sort	managing infective endocarditis in the elderly: new issues for an old disease
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/5ddb40d9171c46198ef7d6aab3d34dbc
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Managing infective endocarditis in the elderly: new issues for an old disease

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