PREVENTION OF INFECTION AT EXTREME AGES OF LIFE

Age-dependent factors : There has been an insufficient amount of work on nosocomial infections in patients at the extreme ages of life, infe ctions in very old or very young patients differ from those in the gen eral adult population for several reasons. immune insufficiency in pre mature infants or the elderly, adverse effects of hospital stay in chi ldren and in the elderly and, also in the elderly, various underlying disease states. Epidemiology data : Among these two groups of patients differences are seen in the bacterial species involved and in the pre dominant sites of infection: in children, nosocomial infections affect the digestive tract more often whereas in the elderly respiratory tra ct infections predominate. Epidemiological investigations have been ca rried out in the two groups, in hospitals and geriatric institutions. Choosing an antibiotic : The choice of antibiotics and their impact on selection and spread of penicillin-resistant-pneumococci, or methicil lin-resistant staphylococci, have given rise to several surveys. In ne onates, among those with early infections, cases of sepsis occurred eq ually in relation to E. coli and group B streptococci, whereas in dela yed infections (> 48h) sepsis was related to Cram-positive organisms i n 80% of cases. Antibiotic consumption has also been surveyed in geria tric units. The findings have led to the definition of strategies for antibiotic usage designed in view of preventing dissemination of resis tant organisms and improving the cost/benefit ratio. it is noteworthy that there is a need for further similar studies, particularly in the elderly.