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MedEdPORTAL. 2018 Sep 21;14:10754. doi: 10.15766/mep_2374-8265.10754.

Infections in Older Adults: A Case-Based Discussion Series Emphasizing Antibiotic Stewardship.

Michener A1, Heath B2, Crnich CJ3,4,5, Moehring R6,7, Schmader K8,9,10, Mody L11,12,13, Branch-Elliman W14,15, Jump RLP16,17,18,19.

Author information

1
Resident, Department of Medicine, Case Western Reserve University School of Medicine.
2
Educational Coordinator, Geriatric Research Education and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center.
3
Chief of Medicine, William S. Middleton VA Hospital.
4
Hospital Epidemiologist, William S. Middleton VA Hospital.
5
Associate Professor of Medicine, Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health.
6
Physician-Epidemiologist, Duke Center for Antimicrobial Stewardship and Infection Prevention.
7
Assistant Professor of Medicine, Division of Infectious Diseases, Duke University Medical Center.
8
Director, Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center.
9
Professor of Medicine, Department of Medicine, Duke University Medical Center.
10
Chief of Geriatrics, Department of Medicine, Duke University Medical Center.
11
Associate Division Chief, Geriatrics Center, University of Michigan.
12
Clinical and Translational Research Director, Geriatrics Center, University of Michigan.
13
Professor of Internal Medicine, Geriatrics Center, University of Michigan.
14
Assistant Professor of Medicine, Veterans Affairs Boston Healthcare System.
15
Assistant Professor of Medicine, Harvard Medical School.
16
Physician-Scientist, Geriatric Research Education and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center.
17
Physician-Scientist, Specialty Care Center of Innovation, Louis Stokes Cleveland Veterans Affairs Medical Center.
18
Assistant Professor of Medicine, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine.
19
Assistant Professor, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine.

Abstract

Introduction:

Compared with younger populations, adults 65 years and older are more likely to suffer infection-related morbidity and mortality, experience antibiotic-related adverse events, and acquire multidrug-resistant organisms. We developed a series of case-based discussions that stressed antibiotic stewardship while addressing management of common infections in older adults.

Methods:

Five 1-hour case-based discussions address recognition, diagnosis, and management of infections common in older adults, including those living in long-term care settings: urinary tract infections, upper respiratory tract infections, lower respiratory tract infections, skin and soft tissue infections, and Clostridium difficile infection. The education was implemented at the skilled nursing centers at 15 Veterans Affairs medical centers. Participants from an array of disciplines completed an educational evaluation for each session as well as a pre- and postcourse knowledge assessment.

Results:

The number of respondents to the educational evaluation administered following each session ranged from 68 to 108. Learners agreed that each session met its learning objectives (4.80-4.89 on a 5-point Likert scale, 5 = strongly agree) and that they were likely to make changes (2.50-2.89 on a 3-point scale, 3 = highly likely to make changes). The average score on the five-question knowledge assessment increased from 3.6 (72%) to 3.9 (78%, p = .06).

Discussion:

By stressing recognition of atypical signs and symptoms of infection in older adults, diagnostic tests, and antibiotic stewardship, this series of five case-based discussions enhanced clinical training of learners from several disciplines.

KEYWORDS:

Antibiotic Stewardship; Antimicrobial Stewardship; Asymptomatic Bacteriuria; Bronchitis; Cellulitis; Clostridium Difficile Infection; Clostridium Infections; Editor's Choice; Nursing Homes; Older Adults; Pneumonia; Urinary Tract Infections

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