@article{gavazzi_correction_2023,
	title = {Correction: {Procalcitonin} to reduce exposure to antibiotics and individualise treatment in hospitalised old patients with pneumonia: a randomised study},
	volume = {23},
	issn = {1471-2318},
	shorttitle = {Correction},
	doi = {10.1186/s12877-023-03818-0},
	language = {eng},
	number = {1},
	journal = {BMC geriatrics},
	author = {Gavazzi, Gaëtan and Drevet, Sabine and Debray, Matthieu and Bosson, Jean Luc and Tidadini, Fatah and Paccalin, Marc and de Wazieres, Benoit and Celarier, Thomas and Bonnefoy, Marc and Vitrat, Virginie},
	month = mar,
	year = {2023},
	pmid = {36997865},
	pmcid = {PMC10064504},
	pages = {189},
}

@article{ncho-mottoh_impact_2023,
	title = {The impact of transoesophageal echocardiography in elderly patients with infective endocarditis},
	volume = {116},
	issn = {18752136},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S1875213623000797},
	doi = {10.1016/j.acvd.2023.04.001},
	language = {en},
	number = {5},
	urldate = {2023-12-06},
	journal = {Archives of Cardiovascular Diseases},
	author = {N’cho-Mottoh, Marie-Paule B. and Erpelding, Marie-Line and Roubaud, Claire and Delahaye, François and Fraisse, Thibaut and Dijos, Marina and Ennezat, Pierre-Vladimir and Fluttaz, Arnaud and Richard, Benjamin and Beaufort, Corinne and Nazeyrollas, Pierre and Brasselet, Camille and Pineau, Olivier and Tattevin, Pierre and Curlier, Elodie and Iung, Bernard and Forestier, Emmanuel and Selton-Suty, Christine},
	month = may,
	year = {2023},
	pages = {258--264},
}

@article{hentzien_external_2023,
	title = {External validation of the {Dat}'{AIDS} score: {A} risk score for predicting 5-year overall mortality in people living with {HIV} aged 60 years or older},
	issn = {1468-1293},
	shorttitle = {External validation of the {Dat}'{AIDS} score},
	doi = {10.1111/hiv.13534},
	abstract = {OBJECTIVE: To perform an external validation of the Dat'AIDS score for predicting 5-year overall mortality among people with HIV (PWH) aged 60 years or older.
METHODS: This was a multi-centre prospective cohort study at all sites participating in the Swiss HIV Cohort Study (SHCS). We calculated the Dat'AIDS score in PWH aged 60 years or older at their first visit between 1 January 2015 and 1 January 2020. People living with HIV-2 and those whose Dat'AIDS score could not be calculated were excluded. Patients were followed until 1 January 2020. The primary endpoint was all-cause mortality. Vital status was collected throughout the study period. We obtained population and score descriptive statistics and assessed the score's discrimination and calibration.
RESULTS: We included 2205 participants (82\% male) of median [interquartile range (IQR)] age 62.0 (60.3-67.0) years, mostly with viraemia {\textless}50 copies/mL (92.7\%). Median follow-up time was 15.9 years and median (IQR) CD4 cell count at enrolment was 586 (420-782) cells/μL. In all, 152 deaths were recorded during a total follow-up period of 7147 patient-years. The median (IQR) observed Dat'AIDS score was 3 (0-8). Discriminative capacities were good as the C-statistic was 0.73 (95\% CI: 0.69-0.77) and consistent across all subgroups. Comparison of observed and expected survival probabilities showed good calibration.
CONCLUSIONS: External validation of the Dat'AIDS score in patients aged 60 years or older showed that it could be a useful tool not only for research purposes, but also to identify older patients at a higher mortality risk and to tailor the most appropriate interventions.},
	language = {eng},
	journal = {HIV medicine},
	author = {Hentzien, Maxime and Frossard, Jaromil and Kouyos, Roger and Prendki, Virginie and Damas, José and Hofmann, Eveline and Braun, Dominique and Schmid, Patrick and Bernasconi, Enos and Ragozzino, Silvio and Efthimiou, Orestis and Delpierre, Cyrille and Allavena, Clotilde and Bani-Sadr, Firouzé and Calmy, Alexandra and {Swiss HIV Cohort Study}},
	month = aug,
	year = {2023},
	pmid = {37619609},
	keywords = {HIV infections/mortality, cohort studies, comorbidity, risk score, validation study},
}

OBJECTIVE: To perform an external validation of the Dat'AIDS score for predicting 5-year overall mortality among people with HIV (PWH) aged 60 years or older. METHODS: This was a multi-centre prospective cohort study at all sites participating in the Swiss HIV Cohort Study (SHCS). We calculated the Dat'AIDS score in PWH aged 60 years or older at their first visit between 1 January 2015 and 1 January 2020. People living with HIV-2 and those whose Dat'AIDS score could not be calculated were excluded. Patients were followed until 1 January 2020. The primary endpoint was all-cause mortality. Vital status was collected throughout the study period. We obtained population and score descriptive statistics and assessed the score's discrimination and calibration. RESULTS: We included 2205 participants (82% male) of median [interquartile range (IQR)] age 62.0 (60.3-67.0) years, mostly with viraemia \textless50 copies/mL (92.7%). Median follow-up time was 15.9 years and median (IQR) CD4 cell count at enrolment was 586 (420-782) cells/μL. In all, 152 deaths were recorded during a total follow-up period of 7147 patient-years. The median (IQR) observed Dat'AIDS score was 3 (0-8). Discriminative capacities were good as the C-statistic was 0.73 (95% CI: 0.69-0.77) and consistent across all subgroups. Comparison of observed and expected survival probabilities showed good calibration. CONCLUSIONS: External validation of the Dat'AIDS score in patients aged 60 years or older showed that it could be a useful tool not only for research purposes, but also to identify older patients at a higher mortality risk and to tailor the most appropriate interventions.

@article{forestier_subcutaneous_2023,
	title = {Subcutaneous antibiotic therapy use by {French} general practitioners: {Its} interest and limitations},
	volume = {53},
	issn = {2666-9919},
	shorttitle = {Subcutaneous antibiotic therapy use by {French} general practitioners},
	doi = {10.1016/j.idnow.2023.104768},
	language = {eng},
	number = {7},
	journal = {Infectious Diseases Now},
	author = {Forestier, Emmanuel and Janosch, Lea and Vitrat, Virginie and Verdon, Renaud and Humbert, Xavier and Gavazzi, Gaetan and Roubaud-Baudron, Claire and {GInGer (Groupe Infectio-Geriatrie)}},
	month = aug,
	year = {2023},
	pmid = {37572989},
	pages = {104768},
}

@article{roseau-vincenti_empirical_2023,
	title = {Empirical antibiotic therapy modalities for {Enterobacteriaceae} bloodstream infections in older patients and their impact on mortality: a multicentre retrospective study},
	issn = {1439-0973},
	shorttitle = {Empirical antibiotic therapy modalities for {Enterobacteriaceae} bloodstream infections in older patients and their impact on mortality},
	doi = {10.1007/s15010-023-02073-0},
	abstract = {PURPOSE: Enterobacteriaceae (EB) bloodstream infections (BSI) are frequent and serious in older patients. Physicians are faced with the dilemma of prescribing early appropriate empirical antibiotics to limit the risk of death, and sparing broad-spectrum antibiotic prescription. The aim of the study was to assess the rate of appropriate empirical antibiotics prescription to treat EB BSI in older patients and its impact on survival.
METHODS: This study conducted in 49 centres enrolled retrospectively up to the 10 last consecutive patients aged 75 years and over and treated for EB BSI. Factors related to in-hospital death were investigated using logistic regression.
RESULTS: Among the 487 enrolled patients (mean age 86 ± 5.9 years), 70\% had at least one risk factor of being infected by third-generation cephalosporins (3GC)-resistant strain; however, only 13.8\% of EB strains were resistant to 3GC. An empirical antimicrobial treatment was initiated for 418 patients (85.8\%), and for 86\% (n = 360/418) of them, it was considered appropriate. In-hospital mortality was 12.7\% (n = 62) and was related to the severity of infection (OR 3.17, CI 95\% 1.75-5.75), while a urinary portal of entry was protective (OR 0.34, CI 95\% 0.19-0.60). Neither the absence of nor inappropriate empirical antibiotics prescription was associated with increased mortality.
CONCLUSION: While patients enrolled in this study were at risk of being infected by multidrug-resistant bacteria, yet mainly treated with 3GC, empirical antibiotics prescription was appropriate in most cases and did not influence mortality.},
	language = {eng},
	journal = {Infection},
	author = {Roseau-Vincenti, Albane and Forestier, Emmanuel and Lanoix, Jean-Philippe and Ricard, Cécile and Carret, Marie-Christine and Caraux-Paz, Pauline and Paccalin, Marc and Gavazzi, Gaëtan and Roubaud-Baudron, Claire and {GInGer group (SPILF-SFGG)}},
	month = aug,
	year = {2023},
	pmid = {37608043},
	keywords = {Bloodstream infection, Elderly, Empirical antimicrobial therapy, Enterobacteriaceae, Functional trajectories},
}

PURPOSE: Enterobacteriaceae (EB) bloodstream infections (BSI) are frequent and serious in older patients. Physicians are faced with the dilemma of prescribing early appropriate empirical antibiotics to limit the risk of death, and sparing broad-spectrum antibiotic prescription. The aim of the study was to assess the rate of appropriate empirical antibiotics prescription to treat EB BSI in older patients and its impact on survival. METHODS: This study conducted in 49 centres enrolled retrospectively up to the 10 last consecutive patients aged 75 years and over and treated for EB BSI. Factors related to in-hospital death were investigated using logistic regression. RESULTS: Among the 487 enrolled patients (mean age 86 ± 5.9 years), 70% had at least one risk factor of being infected by third-generation cephalosporins (3GC)-resistant strain; however, only 13.8% of EB strains were resistant to 3GC. An empirical antimicrobial treatment was initiated for 418 patients (85.8%), and for 86% (n = 360/418) of them, it was considered appropriate. In-hospital mortality was 12.7% (n = 62) and was related to the severity of infection (OR 3.17, CI 95% 1.75-5.75), while a urinary portal of entry was protective (OR 0.34, CI 95% 0.19-0.60). Neither the absence of nor inappropriate empirical antibiotics prescription was associated with increased mortality. CONCLUSION: While patients enrolled in this study were at risk of being infected by multidrug-resistant bacteria, yet mainly treated with 3GC, empirical antibiotics prescription was appropriate in most cases and did not influence mortality.

@article{gavazzi_procalcitonin_2022,
	title = {Procalcitonin to reduce exposure to antibiotics and individualise treatment in hospitalised old patients with pneumonia: a randomised study},
	volume = {22},
	issn = {1471-2318},
	shorttitle = {Procalcitonin to reduce exposure to antibiotics and individualise treatment in hospitalised old patients with pneumonia},
	doi = {10.1186/s12877-022-03658-4},
	abstract = {BACKGROUND: Treating pneumonia in old patients remains challenging for clinicians. Moreover, bacterial antimicrobial resistance is a major public health threat.
OBJECTIVE: The PROPAGE study evaluated the interest of a strategy using serial measurements of procalcitonin (PCT) to reduce the duration of antibiotic therapy in old patients with pneumonia.
METHODS: PROPAGE took place from Dec.-2013 to Jun.-2016 in eight French geriatric units. It was a prospective, comparative, randomised, open-label study involving old patients (≥ 80 years) who had initiated antibiotic treatment for pneumonia in the previous 48 h. PCT was monitored in all patients and two decision-making PCT-based algorithms guided antibiotic therapy in patients from the PCT group.
RESULTS: 107 patients were randomised (PCT, n = 50; Control, n = 57). Antibiotic therapy exposure was reduced in the PCT group as compared to the Control group (median duration of antibiotic therapy, 8 vs. 10 days [rank-test, p = 0.001]; antibiotic persistence rates on Days 6 and 8, 54\% and 44\% vs. 91\% and 72\%) and no significant difference was found in recovery rate (84\% vs. 89.5\%; Pearson Chi² test, p = 0.402).
CONCLUSION: Although, the superiority of the strategy was not tested using a composite criterion combining antibiotic therapy duration and recovery rate was not tested due to the small sample size, the present study showed that monitoring associated with PCT-guided algorithm could help shorten antibiotic treatment duration in the very old patients without detrimental effects. Measuring PCT levels between Day 4 and Day 6 could be helpful when making the decision regarding antibiotic discontinuation.
TRIAL REGISTRATION: NCT02173613. This study was first registered on 25/06/2014.},
	language = {eng},
	number = {1},
	journal = {BMC geriatrics},
	author = {Gavazzi, Gaëtan and Drevet, Sabine and Debray, Matthieu and Bosson, Jean Luc and Tidadini, Fatah and Paccalin, Marc and de Wazieres, Benoit and Celarier, Thomas and Bonnefoy, Marc and Vitrat, Virginie},
	month = dec,
	year = {2022},
	pmid = {36517740},
	pmcid = {PMC9748380},
	keywords = {Aged, Anti-Bacterial Agents, Antibiotic duration, Bacterial Infections, Bacterial infection biomarkers, Biomarkers, Humans, Pneumonia, Procalcitonin, Prospective Studies},
	pages = {965},
}

BACKGROUND: Treating pneumonia in old patients remains challenging for clinicians. Moreover, bacterial antimicrobial resistance is a major public health threat. OBJECTIVE: The PROPAGE study evaluated the interest of a strategy using serial measurements of procalcitonin (PCT) to reduce the duration of antibiotic therapy in old patients with pneumonia. METHODS: PROPAGE took place from Dec.-2013 to Jun.-2016 in eight French geriatric units. It was a prospective, comparative, randomised, open-label study involving old patients (≥ 80 years) who had initiated antibiotic treatment for pneumonia in the previous 48 h. PCT was monitored in all patients and two decision-making PCT-based algorithms guided antibiotic therapy in patients from the PCT group. RESULTS: 107 patients were randomised (PCT, n = 50; Control, n = 57). Antibiotic therapy exposure was reduced in the PCT group as compared to the Control group (median duration of antibiotic therapy, 8 vs. 10 days [rank-test, p = 0.001]; antibiotic persistence rates on Days 6 and 8, 54% and 44% vs. 91% and 72%) and no significant difference was found in recovery rate (84% vs. 89.5%; Pearson Chi² test, p = 0.402). CONCLUSION: Although, the superiority of the strategy was not tested using a composite criterion combining antibiotic therapy duration and recovery rate was not tested due to the small sample size, the present study showed that monitoring associated with PCT-guided algorithm could help shorten antibiotic treatment duration in the very old patients without detrimental effects. Measuring PCT levels between Day 4 and Day 6 could be helpful when making the decision regarding antibiotic discontinuation. TRIAL REGISTRATION: NCT02173613. This study was first registered on 25/06/2014.

@article{henri_survey_2022,
	title = {[{Survey} on antibiotic prescription practices for palliative care terminally ill patients of 75 years old and more]},
	volume = {43},
	issn = {1768-3122},
	doi = {10.1016/j.revmed.2022.08.011},
	abstract = {Infections commonly occur terminally ill oldest patients in palliative care and questioned about antimicrobial use. The aim of this study was to describe practitioners' habits.
METHOD: ancillary study on antibiotic modalities according to the setting of care from a national practices survey based on self administered questionnaire sent by e-mail in 2017.
RESULTS: 220 practitioners/327 used antibiotic, 136 worked in hospital department (52 geriatricians), 20 nursing home and 64 general practitioners (GP). GP declared less palliative care patients (6/year). The antibiotic goal was symptomatic relief for 181 (82.3\%) without statistically significant difference between groups. GP (25\%) were the group that most collected patient opinion for antibiotic prescription. Nursing home (23\%) and GP (18\%) reported more urinary tract symptoms than others (11.7\%) (P=0.003). Geriatricians (59.6\%) declared significantly less urinary analysis than GP (90\%) (P=0.0009). 212 doctor (96.4\%) faced side effect (SI): more allergic reaction and less administration difficulties than the other groups. The stop decision was collegially took (156, 70,9\%) significantly more in hospital (121, 89\%) than in community (25, 39.1\%) (P{\textless}0.001). Patient wishes were noted by 30 (46.96\%) only GP.
CONCLUSION: Even if practice and number of patients follow up differ from each place of care, doctors' intention in antibiotic use respect palliative care goal to relieve discomfort. It is hard to diagnose infection and complementary exam are scarce. A repeated individualized evaluation with patient, his surrounding and his medical referent participation, is mandatory to give a constant adapted level of care in every place of care.},
	language = {fre},
	number = {10},
	journal = {La Revue De Medecine Interne},
	author = {Henri, B. and Sirvain, S. and de Wazieres, B. and M Durand, null and Bernard, L. and Gavazzi, G. and Forestier, E. and Fraisse, T. and {Ginger}},
	month = oct,
	year = {2022},
	pmid = {36064626},
	keywords = {Aged, Anti-Bacterial Agents, Antibiothérapie, Antibiotic drug, Cross-Sectional Studies, End of live, Fin de vie, General Practitioners, Humans, Palliative Care, Patient of 75 years and more, Patients de plus de 75 ans, Prescriptions, Surveys and Questionnaires, Terminally Ill},
	pages = {589--595},
}

Infections commonly occur terminally ill oldest patients in palliative care and questioned about antimicrobial use. The aim of this study was to describe practitioners' habits. METHOD: ancillary study on antibiotic modalities according to the setting of care from a national practices survey based on self administered questionnaire sent by e-mail in 2017. RESULTS: 220 practitioners/327 used antibiotic, 136 worked in hospital department (52 geriatricians), 20 nursing home and 64 general practitioners (GP). GP declared less palliative care patients (6/year). The antibiotic goal was symptomatic relief for 181 (82.3%) without statistically significant difference between groups. GP (25%) were the group that most collected patient opinion for antibiotic prescription. Nursing home (23%) and GP (18%) reported more urinary tract symptoms than others (11.7%) (P=0.003). Geriatricians (59.6%) declared significantly less urinary analysis than GP (90%) (P=0.0009). 212 doctor (96.4%) faced side effect (SI): more allergic reaction and less administration difficulties than the other groups. The stop decision was collegially took (156, 70,9%) significantly more in hospital (121, 89%) than in community (25, 39.1%) (P\textless0.001). Patient wishes were noted by 30 (46.96%) only GP. CONCLUSION: Even if practice and number of patients follow up differ from each place of care, doctors' intention in antibiotic use respect palliative care goal to relieve discomfort. It is hard to diagnose infection and complementary exam are scarce. A repeated individualized evaluation with patient, his surrounding and his medical referent participation, is mandatory to give a constant adapted level of care in every place of care.

@article{baclet_explicit_2022,
	title = {Explicit definitions of potentially inappropriate prescriptions of antibiotics in hospitalized older patients},
	issn = {26669919},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S2666991922000379},
	doi = {10.1016/j.idnow.2022.02.004},
	language = {en},
	urldate = {2022-02-24},
	journal = {Infectious Diseases Now},
	author = {Baclet, N and Calafiore, M and Fregnac, C and Gavazzi, G and Forestier, E and Roubaud-Baudron, C and Fraisse, T and Alfandari, S and Senneville, E and Beuscart, J-B},
	month = feb,
	year = {2022},
	pages = {S2666991922000379},
}

@article{piet_outbreaks_2021,
	title = {Outbreaks of {COVID}-19 in {Nursing} {Homes}: {A} {Cross}-{Sectional} {Survey} of 74 {Nursing} {Homes} in a {French} {Area}},
	volume = {10},
	issn = {2077-0383},
	shorttitle = {Outbreaks of {COVID}-19 in {Nursing} {Homes}},
	url = {https://www.mdpi.com/2077-0383/10/18/4280},
	doi = {10.3390/jcm10184280},
	abstract = {In this multi-centric cross-sectional survey conducted in nursing homes of the French Alps, from 1 March to 31 May 2020, we analyze the relationship between the occurrence of an outbreak of COVID 19 among residents and staff members. Out of 225 eligible nursing homes, 74 (32.8\%) completed the survey. Among 5891 residents, the incidence of confirmed or probable COVID-19 was 8.2\% (95CI, 7.5\% to 8.9\%), and 22 (29.7\%) facilities had an outbreak with at least 3 cases. Among the 4652 staff members, the incidence of confirmed or probable COVID-19 was 6.3\% (95CI, 5.6\% to 7.1\%). A strong positive correlation existed between residents and staff members for both numbers of cases (r2 = 0.77, p {\textless} 0.001) and the incidence (r2 = 0.76, p {\textless} 0.001). In univariate analyses, cases among the staff were the only factor associated with the occurrence of an outbreak among residents (OR = 11.2 (95CI, 2.25 to 53.6)). In bivariate analysis, this relationship was not influenced by any nursing home characteristics, nor the action they implemented to mitigate the COVID-19 crisis. Staff members were, therefore, likely to be a source of contamination and spread of COVID-19 among nursing home residents during the first wave of the pandemic.},
	language = {en},
	number = {18},
	urldate = {2023-12-06},
	journal = {Journal of Clinical Medicine},
	author = {Piet, Emilie and Maillard, Alexis and Mallaval, Franck Olivier and Dusseau, Jean Yves and Galas-Haddad, Murielle and Ducki, Sébastien and Creton, Hélène and Lallemant, Marc and Forestier, Emmanuel and Gavazzi, Gaëtan and Delory, Tristan},
	month = sep,
	year = {2021},
	pages = {4280},
}

In this multi-centric cross-sectional survey conducted in nursing homes of the French Alps, from 1 March to 31 May 2020, we analyze the relationship between the occurrence of an outbreak of COVID 19 among residents and staff members. Out of 225 eligible nursing homes, 74 (32.8%) completed the survey. Among 5891 residents, the incidence of confirmed or probable COVID-19 was 8.2% (95CI, 7.5% to 8.9%), and 22 (29.7%) facilities had an outbreak with at least 3 cases. Among the 4652 staff members, the incidence of confirmed or probable COVID-19 was 6.3% (95CI, 5.6% to 7.1%). A strong positive correlation existed between residents and staff members for both numbers of cases (r2 = 0.77, p \textless 0.001) and the incidence (r2 = 0.76, p \textless 0.001). In univariate analyses, cases among the staff were the only factor associated with the occurrence of an outbreak among residents (OR = 11.2 (95CI, 2.25 to 53.6)). In bivariate analysis, this relationship was not influenced by any nursing home characteristics, nor the action they implemented to mitigate the COVID-19 crisis. Staff members were, therefore, likely to be a source of contamination and spread of COVID-19 among nursing home residents during the first wave of the pandemic.

@article{forestier_managing_2021,
	title = {Managing infective endocarditis in older patients: do we need a geriatrician?},
	volume = {33},
	issn = {1720-8319},
	shorttitle = {Managing infective endocarditis in older patients},
	url = {http://link.springer.com/10.1007/s40520-019-01400-6},
	doi = {10.1007/s40520-019-01400-6},
	language = {en},
	number = {3},
	urldate = {2022-02-24},
	journal = {Aging Clinical and Experimental Research},
	author = {Forestier, Emmanuel and Selton-Suty, Christine and Roubaud-Baudron, Claire},
	month = mar,
	year = {2021},
	pages = {719--722},
}

@article{caraux-paz_tuberculosis_2021,
	title = {Tuberculosis in the {Elderly}},
	volume = {10},
	issn = {2077-0383},
	url = {https://www.mdpi.com/2077-0383/10/24/5888},
	doi = {10.3390/jcm10245888},
	abstract = {The tuberculosis (TB) epidemic is most prevalent in the elderly, and there is a progressive increase in the notification rate with age. Most cases of TB in the elderly are linked to the reactivation of lesions that have remained dormant. The awakening of these lesions is attributable to changes in the immune system related to senescence. The mortality rate from tuberculosis remains higher in elderly patients. Symptoms of active TB are nonspecific and less pronounced in the elderly. Diagnostic difficulties in the elderly are common in many diseases but it is important to use all possible techniques to make a microbiological diagnosis. Recognising frailty to prevent loss of independence is a major challenge in dealing with the therapeutic aspects of elderly patients. Several studies report contrasting data about poorer tolerance of TB drugs in this population. Adherence to antituberculosis treatment is a fundamental issue for the outcome of treatment. Decreased completeness of treatment was shown in older people as well as a higher risk of treatment failure.},
	language = {en},
	number = {24},
	urldate = {2022-02-24},
	journal = {Journal of Clinical Medicine},
	author = {Caraux-Paz, Pauline and Diamantis, Sylvain and de Wazières, Benoit and Gallien, Sébastien},
	month = dec,
	year = {2021},
	pages = {5888},
}

The tuberculosis (TB) epidemic is most prevalent in the elderly, and there is a progressive increase in the notification rate with age. Most cases of TB in the elderly are linked to the reactivation of lesions that have remained dormant. The awakening of these lesions is attributable to changes in the immune system related to senescence. The mortality rate from tuberculosis remains higher in elderly patients. Symptoms of active TB are nonspecific and less pronounced in the elderly. Diagnostic difficulties in the elderly are common in many diseases but it is important to use all possible techniques to make a microbiological diagnosis. Recognising frailty to prevent loss of independence is a major challenge in dealing with the therapeutic aspects of elderly patients. Several studies report contrasting data about poorer tolerance of TB drugs in this population. Adherence to antituberculosis treatment is a fundamental issue for the outcome of treatment. Decreased completeness of treatment was shown in older people as well as a higher risk of treatment failure.

@article{hernandez-ruiz_subcutaneous_2021,
	title = {Subcutaneous {Antibiotic} {Therapy}: {The} {Why}, {How}, {Which} {Drugs} and {When}},
	volume = {22},
	issn = {15258610},
	shorttitle = {Subcutaneous {Antibiotic} {Therapy}},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S1525861020303637},
	doi = {10.1016/j.jamda.2020.04.035},
	language = {en},
	number = {1},
	urldate = {2022-02-24},
	journal = {Journal of the American Medical Directors Association},
	author = {Hernández-Ruiz, Virgilio and Forestier, Emmanuel and Gavazzi, Gaëtan and Ferry, Tristan and Grégoire, Nicolas and Breilh, Dominique and Paccalin, Marc and Goutelle, Sylvain and Roubaud-Baudron, Claire},
	month = jan,
	year = {2021},
	pages = {50--55.e6},
}

@article{durand_determinants_2021,
	title = {Determinants of doctors’ antibiotic prescriptions for patients over 75 years old in the terminal stage of palliative care},
	volume = {51},
	issn = {26669919},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S0399077X2030740X},
	doi = {10.1016/j.medmal.2020.10.013},
	language = {en},
	number = {4},
	urldate = {2022-02-24},
	journal = {Infectious Diseases Now},
	author = {Durand, M. and Forestier, E. and Gras Aygon, C. and Sirvain, S. and de Wazières, B. and Bernard, L. and Paccalin, M. and Legout, L. and Roubaud Baudron, C. and Gavazzi, G. and Fraisse, T.},
	month = jun,
	year = {2021},
	pages = {340--345},
}

@article{sirvain_antibiotics_2021,
	title = {Antibiotics in end of life: {The} driving factors},
	issn = {26669919},
	shorttitle = {Antibiotics in end of life},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S2666991921005169},
	doi = {10.1016/j.idnow.2021.10.004},
	language = {en},
	urldate = {2022-02-24},
	journal = {Infectious Diseases Now},
	author = {Sirvain, Serge and Durand, Mailys and Putot, Alain and Forestier, Emmanuel and Gavazzi, Gaetan and Fraisse, Thibaut},
	month = oct,
	year = {2021},
	pages = {S2666991921005169},
}

@article{caupenne_acute_2020,
	title = {Acute {Clostridioides} difficile {Infection} in {Hospitalized} {Persons} {Aged} 75 and {Older}: 30-{Day} {Prognosis} and {Risk} {Factors} for {Mortality}},
	volume = {21},
	issn = {15258610},
	shorttitle = {Acute {Clostridioides} difficile {Infection} in {Hospitalized} {Persons} {Aged} 75 and {Older}},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S1525861019305250},
	doi = {10.1016/j.jamda.2019.07.002},
	language = {en},
	number = {1},
	urldate = {2023-12-06},
	journal = {Journal of the American Medical Directors Association},
	author = {Caupenne, Arnaud and Ingrand, Pierre and Ingrand, Isabelle and Forestier, Emmanuel and Roubaud-Baudron, Claire and Gavazzi, Gaëtan and Paccalin, Marc},
	month = jan,
	year = {2020},
	pages = {110--114},
}

@article{forestier_comprehensive_2019,
	title = {Comprehensive geriatric assessment in older patients suffering from infective endocarditis. {A} prospective multicentric cohort study},
	volume = {25},
	issn = {1198743X},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S1198743X19301983},
	doi = {10.1016/j.cmi.2019.04.021},
	language = {en},
	number = {10},
	urldate = {2022-02-24},
	journal = {Clinical Microbiology and Infection},
	author = {Forestier, E. and Roubaud-Baudron, C. and Fraisse, T. and Patry, C. and Gavazzi, G. and Hoen, B. and Carauz-Paz, P. and Moheb-Khosravi, B. and Delahaye, F. and Sost, G. and Paccalin, M. and Nazeyrollas, P. and Strady, C. and Alla, F. and Selton-Suty, C. and Schambach, S. and Vallette, d’O. and Khosravi, B.M. and Patry, C. and Roubaud, C. and Lafargue, A. and Guerville, F. and Kobeh, D. and Averty, E. and Thiennaud, L. and Soulas, E. and Gavazzi, G. and Basileu, T. and Chuzeville, M. and Laurain, M.-C. and Paccalin, M. and Novella, J.L. and Bertholon, L.A. and Jaidi, Y. and Guiard, R. and Sost, G. and Naturel, J. and Fraisse, T. and Vitrat, V. and Duval, X. and Wirth, G. and Forestier, E. and Pavese, P. and Pierre, I. and Hoen, B. and Fernandes, É. and Curlier, E. and Boibieux, A. and Goehringer, F. and Béraud, G. and Nguyen, Y. and Strady, C. and Tattevin, P. and Revest, M. and Piau, C. and Paz, P.C. and Vançon, A.-C. and Naem, N. and Richard, B. and Iung, B. and Dijos, M. and Fluttaz, A. and Ennezat, P.-V. and Delahaye, F. and Selton-Suty, C. and Beaufort, C. and Nazeyrollas, P. and Torossian, F. and Brasselet, C. and Donal, E. and Pineau, O. and Alla, F. and Agrinier, N. and Erpelding, M.-L. and Sime, W.N. and Clavère, G. and Lebouc, M. and Ilic-Habensus, E. and Durrieu, J. and Habet, T. and Dupré, C. and Chaissac, A.-M. and Touati, S. and Delahaye, A. and Marquis, E. and Warchol, M. and Thébault, E. and Jouan, C. and Campagnac, C. and Petitgenêt, I.},
	month = oct,
	year = {2019},
	pages = {1246--1252},
}

@article{prendki_efficacy_2017,
	title = {Efficacy of indefinite chronic oral antimicrobial suppression for prosthetic joint infection in the elderly: a comparative study},
	volume = {60},
	issn = {12019712},
	shorttitle = {Efficacy of indefinite chronic oral antimicrobial suppression for prosthetic joint infection in the elderly},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S1201971217301443},
	doi = {10.1016/j.ijid.2017.05.008},
	language = {en},
	urldate = {2023-12-06},
	journal = {International Journal of Infectious Diseases},
	author = {Prendki, V. and Sergent, P. and Barrelet, A. and Oziol, E. and Beretti, E. and Berlioz-Thibal, M. and Bouchand, F. and Dauchy, F.A. and Forestier, E. and Gavazzi, G. and Ronde-Oustau, C. and Stirnemann, J. and Dinh, A.},
	month = jul,
	year = {2017},
	pages = {57--60},
}

@article{prendki_prolonged_2017,
	title = {Prolonged suppressive antibiotic therapy for prosthetic joint infection in the elderly: a national multicentre cohort study},
	volume = {36},
	issn = {0934-9723, 1435-4373},
	shorttitle = {Prolonged suppressive antibiotic therapy for prosthetic joint infection in the elderly},
	url = {http://link.springer.com/10.1007/s10096-017-2971-2},
	doi = {10.1007/s10096-017-2971-2},
	language = {en},
	number = {9},
	urldate = {2023-12-06},
	journal = {European Journal of Clinical Microbiology \& Infectious Diseases},
	author = {Prendki, V. and Ferry, T. and Sergent, P. and Oziol, E. and Forestier, E. and Fraisse, T. and Tounes, S. and Ansart, S. and Gaillat, J. and Bayle, S. and Ruyer, O. and Borlot, F. and Le Falher, G. and Simorre, B. and Dauchy, F.-A. and Greffe, S. and Bauer, T. and Bell, E. N. and Martha, B. and Martinot, M. and Froidure, M. and Buisson, M. and Waldner, A. and Lemaire, X. and Bosseray, A. and Maillet, M. and Charvet, V. and Barrelet, A. and Wyplosz, B. and Noaillon, M. and Denes, E. and Beretti, E. and Berlioz-Thibal, M. and Meyssonnier, V. and Fourniols, E. and Tliba, L. and Eden, A. and Jean, M. and Arvieux, C. and Guignery-Kadri, K. and Ronde-Oustau, C. and Hansmann, Y. and Belkacem, A. and Bouchand, F. and Gavazzi, G. and Herrmann, F. and Stirnemann, J. and Dinh, A.},
	month = sep,
	year = {2017},
	pages = {1577--1585},
}

@article{roubaud-baudron_tolerance_2017,
	title = {Tolerance of subcutaneously administered antibiotics: a {French} national prospective study},
	volume = {46},
	issn = {1468-2834},
	shorttitle = {Tolerance of subcutaneously administered antibiotics},
	doi = {10.1093/ageing/afw143},
	abstract = {BACKGROUND/ OBJECTIVE: Although poorly documented, subcutaneous (SC) administration of antibiotics is common practice in France especially in Geriatrics Departments. The aim of this study was to determine the tolerance of such a practice.
DESIGN: Prospective observational multicentre study.
METHODS: Sixty-six physicians accepted to participate from 50 French Infectious Diseases and Geriatrics Departments. From May to September 2014, patients treated at least one day with SC antibiotics could be included. Modalities of subcutaneous administration, occurrence of local and systemic adverse effects (AE) and clinical course were collected until the end of the treatment.
RESULTS: Two hundred-nineteen patients (83.0 [19–104] yo) were included. Ceftriaxone (n = 163, 74.4\%), and ertapenem (n = 30, 13.7\%) were the most often prescribed antibiotics. The SC route was mainly used because of poor venous access (65.3\%) and/or palliative care (32.4\%). Fifty patients (22.8\%) experienced at least one local AE that led to an increased hospital stay for two patients (4.0\%) and a discontinuation of the SC infusion in six patients (12.0\%). A binary logistic regression for multivariate analysis identified the class of antibiotic (p = 0.002) especially teicoplanin and the use of rigid catheter (p = 0.009) as factors independently associated with AE. In over 80\% of cases, SC antibiotics were well tolerated and associated with clinical recovery.
CONCLUSIONS: SC administration of antibiotics leads to frequent but local and mild AE. Use of non-rigid catheter appears to be protective against AE. As it appears to be a safe alternative to the intravenous route, more studies are needed regarding efficacy and pharmacokinetics.},
	language = {eng},
	number = {1},
	journal = {Age and Ageing},
	author = {Roubaud-Baudron, Claire and Forestier, Emmanuel and Fraisse, Thibaut and Gaillat, Jacques and de Wazières, Benoit and Pagani, Leonardo and Ingrand, Isabelle and Bernard, Louis and Gavazzi, Gaëtan and Paccalin, Marc},
	month = jan,
	year = {2017},
	pmid = {28181635},
	keywords = {Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Bacterial Infections, Catheters, Drug Administration Schedule, Drug-Related Side Effects and Adverse Reactions, Equipment Design, Female, France, Humans, Infusions, Subcutaneous, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Prospective Studies, Risk Factors, Time Factors, Young Adult},
	pages = {151--155},
}

BACKGROUND/ OBJECTIVE: Although poorly documented, subcutaneous (SC) administration of antibiotics is common practice in France especially in Geriatrics Departments. The aim of this study was to determine the tolerance of such a practice. DESIGN: Prospective observational multicentre study. METHODS: Sixty-six physicians accepted to participate from 50 French Infectious Diseases and Geriatrics Departments. From May to September 2014, patients treated at least one day with SC antibiotics could be included. Modalities of subcutaneous administration, occurrence of local and systemic adverse effects (AE) and clinical course were collected until the end of the treatment. RESULTS: Two hundred-nineteen patients (83.0 [19–104] yo) were included. Ceftriaxone (n = 163, 74.4%), and ertapenem (n = 30, 13.7%) were the most often prescribed antibiotics. The SC route was mainly used because of poor venous access (65.3%) and/or palliative care (32.4%). Fifty patients (22.8%) experienced at least one local AE that led to an increased hospital stay for two patients (4.0%) and a discontinuation of the SC infusion in six patients (12.0%). A binary logistic regression for multivariate analysis identified the class of antibiotic (p = 0.002) especially teicoplanin and the use of rigid catheter (p = 0.009) as factors independently associated with AE. In over 80% of cases, SC antibiotics were well tolerated and associated with clinical recovery. CONCLUSIONS: SC administration of antibiotics leads to frequent but local and mild AE. Use of non-rigid catheter appears to be protective against AE. As it appears to be a safe alternative to the intravenous route, more studies are needed regarding efficacy and pharmacokinetics.

@article{forestier_managing_2016,
	title = {Managing infective endocarditis in the elderly: new issues for an old disease},
	volume = {11},
	issn = {1178-1998},
	shorttitle = {Managing infective endocarditis in the elderly},
	doi = {10.2147/CIA.S101902},
	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.},
	language = {eng},
	journal = {Clinical Interventions in Aging},
	author = {Forestier, Emmanuel and Fraisse, Thibaut and Roubaud-Baudron, Claire and Selton-Suty, Christine and Pagani, Leonardo},
	year = {2016},
	pmid = {27621607},
	pmcid = {PMC5015881},
	keywords = {Aged, Aged, 80 and over, Anti-Bacterial Agents, Cardiac Surgical Procedures, Comorbidity, Disease Management, Endocarditis, Frail Elderly, Humans, Incidence, Practice Guidelines as Topic, Risk Factors, antibiotic therapy, cardiac surgery, elderly, frailty, infective endocarditis},
	pages = {1199--1206},
}

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.