Aeromonas bacteremia in an elderly immunocompetent patient

We report the case of an elderly immunocompetent patient with Aeromonas hydrophila bacteremia without evidence of portal of entry. Despite several risk factors for a poor outcome, such as impaired renal function, two positive blood cultures, and community-acquired infections, the patient survived. Antimicrobial susceptibility was normal. Unknown polycystic liver disease was discovered and misdiagnosed as a hepatic abscess at the time of the bacteremia which was confirmed by repeated CT scans. Because of the absence of other risk factors for Aeromonas bacteremia, hepatic polycystic disease may take part in the onset of Aeromonas sp bacteremia as well as immunosenescenc

Prevalence and prediction of previously unknown MRSA carriage on admission to a geriatric hospital

Objectives: to determine the prevalence and characteristics of previously unknown methicillin-resistant Staphylococcus aureus (MRSA) carriers at admission. Design: two prospective case-control studies. Subjects: 1,621 elderly patients were screened for MRSA carriage within 24 hours after admission to a geriatric hospital in Geneva, Switzerland. Methods: risk factors associated with previously unknown MRSA carriage were determined in the derivation group, and the resulting risk score was evaluated in the validation cohort using logistic regression analysis. Results: prevalence of MRSA carriage at admission increased from 7.3% (53/724 patients) in 2001 to 8.7% (78/897 patients) in 2003, with a corresponding prevalence of unknown MRSA carriers of 4.6 and 5.8%, respectively. Three variables were independently associated with previously unknown MRSA carriage: recent antibiotic treatment (adjusted OR (aOR) 2.3; 95% CI 1.0-5.1), intra-hospital transfer (aOR 2.5; 95% CI 1.2-5.3), and hospitalization in the past 2 years (aOR 2.7; 95% CI 1.1-6.7). In the validation cohort, the probability of MRSA carriage increased across risk scores: 0 point, 4% prevalence (6/146); 1 point, 15% (21/136); and $2 points, 31% (21/68; P<0.001). The risk score showed good discrimination and calibration in both groups. Conclusions: our risk score, which used a simple additive point system to estimate the likelihood of unknown MRSA carriage, had good accuracy and generalised well in an independent sample of patients. Once validated in a clinical trial, our risk score may be used as a tool to optimise MRSA contro

Considerations for the optimal management of antibiotic therapy in elderly patients

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Management of anaphylaxis due to COVID-19 vaccines in the elderly

Older adults, especially men and/or those with diabetes, hypertension, and/or obesity, are prone to severe COVID-19. In some countries, older adults, particularly those residing in nursing homes, have been prioritized to receive COVID-19 vaccines due to high risk of death. In very rare instances, the COVID-19 vaccines can induce anaphylaxis, and the management of anaphylaxis in older people should be considered carefully. An ARIA-EAACI-EuGMS (Allergic Rhinitis and its Impact on Asthma, European Academy of Allergy and Clinical Immunology, and European Geriatric Medicine Society) Working Group has proposed some recommendations for older adults receiving the COVID-19 vaccines. Anaphylaxis to COVID-19 vaccines is extremely rare (from 1 per 100,000 to 5 per million injections). Symptoms are similar in younger and older adults but they tend to be more severe in the older patients. Adrenaline is the mainstay treatment and should be readily available. A flowchart is proposed to manage anaphylaxis in the older patients.Peer reviewe

Evaluation de la fonction de NOX1 sur modèle animal transgènique

The NOX family enzyme is constituted by Superoxide-generating NADPH oxidases homologues of gp91Phox; as the well characterized NOX2 (new denomination for gp91Phox) their catalytic subunit exhibits a common structure of 6 or 7 transmemmbrane domaine (ROS). The total number of enzymes in the family increased to 7 throught the past 5 years ; it includes, NOX1, NOX2, NOX3, NOX4, NOX5 et DUOX 1 et DUOX2 ; Tissue and cellular distributions of mRNA expression of the enzymes are well defined and show that superoxide generating enzyme are quasi-ubiquitous. General functions are Reactive oxygen species (ROS) dependent but their cellular localisations are of importance. NOX2 produces ROS in stimulated phagocytes and is the known microbicidal enzyme. NOX3 is responsible for vestibular dysfunction and DUOX1 and DUOX 2 allow iodination to thyroglobuline resulting in biosynthesis of thyroid hormon. While mRNA expressions of the other NOXs (namely NOX1, NOX4 and NOX5) are well defined, their biological functions are still not known. In vitro and ex vivo data provide only indirect informations which not allow understanding complexes interplay of the biological function. We have then generated NOX1-deficient mice to further investigate directly the in vivo functions of NOX1 in colon and vascular tissues. First, we used a F3 generation mice to determine whether NOX1 participate in the antibacterial defences and whether it limits bacterial translocation. We show that NOX1 is involved in the severity of Dextran Sulfate Sodium induced colitis via bacterial colonic flora and decrease the bacterial translocation in the gut. However, we have to be cautious because of the weakness of homology of the genetic background (87.5%) which in turn, may modify the results.Second, we investigated whether NOX1 regulates basal blood pressure and participates in angiotensin II induced hypertension. All experiments were realized with F6 generation mice. NOX1-deficient mice had lower basal blood pressure, an almost complete loss of sustained blood pressure response to angiotensin II and were strongly protected from ATII-induced aortic dissection. Our results establish an important role for NOX1 in the vascular ATII response, in particular extracellular matrix accumulation, regulation of gene expression, and cross talk with the nitric oxide system.Les NOX Homologues représentent une nouvelle famille de protéines transmembranaires dont la caractéristique commune est d'être le cœur catalytique de la production d'anions superoxydes. Elles ont toutes une structure proche de NOX2 (ou gp91Phox selon l'ancienne nomenclature), la mieux caractérisée d'entre elles, et sont organisées en 6 ou 7 domaines transmembranaires. Cette famille compte actuellement 7 membres, NOX1, NOX2, NOX3, NOX4, NOX5 et DUOX 1 et DUOX2 ; elles ont une distribution tissulaire, cellulaire et intracellulaire spécifique les rendant quasi ubiquitaires dans l'organisme. Les fonctions de ces enzymes sont essentiellement rattachées à celles des espèces réactives de l'oxygène (ERO) mais dépendent aussi de leurs localisations. NOX2 est l'enzyme à l'origine de la production des ERO des phagocytes activés et a donc une fonction antimicrobienne. NOX3 est impliquée dans les pathologies du système vestibulaire et les DUOX1 et 2 sont des éléments clés de la biosynthèse des hormones thyroïdiennes. Les autres NOX, (NOX1, NOX4, NOX5), individualisées depuis quelques années seulement, ont une distribution tissulaire et cellulaire d'expression ARNm bien caractérisée, mais les données sur leurs fonctions physiologiques ou physiopathologiques restent fragmentaires ; Ces données sont le plus souvent issues d'expérimentations in vitro ou ex vivo n'évaluant leurs fonctions que de façon indirecte ou dans des systèmes simplifiés. Ainsi, en utilisant un modèle animal de souris déficientes pour le gène NOX1 établi dans le laboratoire, nous avons évalué directement la fonction de NOX1 dans le colon et dans le système vasculaire. La première partie de ce travail a eu pour objectif de déterminer si NOX1 exerce une activité antibactérienne au niveau du colon et participe au contrôle de la translocation bactérienne à travers la muqueuse colique. NOX1 participe à la sévérité de la colite au Dextran Sulfate Sodium par l'intermédiaire de la flore colique et protège de la translocation bactérienne dans un modèle de neutropénie induite. Cependant, ces résultats devront être confirmés car les expérimentations ont toutes été réalisées avec des souris dont le fond génétique n'avait une homologie que de 87.5%. La seconde partie de notre travail devait déterminer si NOX1 exerce une activité régulatrice de la pression artérielle systolique et participe à la survenue de l'hypertension artérielle induite par l'angiotensine II. Nous montrons, avec des souris de génération F6 (homologie>98.5%), que NOX1 participe à la régulation physiologique de la pression artérielle, à la survenue de l'hypertension artérielle induite par l'angiotensine II et à la survenue de dissection aortique. NOX1 agit dans le tissu vasculaire par au moins 3 mécanismes, en favorisant l'accumulation de matrice extracellulaire, en régulant l'expression génique et en diminuant la biodisponibilité du NO

Infections in the older population: what do we know?

The incidence of infections increases with age and results in a higher risk of morbidity and mortality. This rise is not mainly related to chronological age per se but has been linked mostly to individual factors such as immunosenescence; the presence of comorbidities; the occurrence of geriatric syndromes such as poor nutrition, polypharmacy, and cognitive disorders; and the presence of functional impairment concomitant with environmental, healthcare-related and microbiological factors such as the increasing risk of multidrug-resistant microorganisms. The geriatric concept of frailty introduces a new approach for considering the risk of infection; this concept highlights the importance of functional status and is a more comprehensive and multicomponent approach that may help to reverse the vulnerability to stress. The aim of this article is to provide some typical hallmarks of infections among older adults in comparison to younger individuals. The main differences among the older population that are presented are an increased prevalence of infections and potential risk factors, a higher risk of carrying multidrug-resistant microorganisms, an increase in barriers to a prompt diagnosis related to atypical presentations and challenges with diagnostic tools, a higher risk of under- and over-diagnosis, a worse prognosis with a higher risk of acute and chronic complications and a particular need for better communication among all healthcare sectors as they are closely linked together