Fiebre e infección

IDSA GUIDELINES

Clinical Practice Guideline for the Evaluation of Fever and Infection in Older Adult Residents of Long-Term Care Facilities: 2008 Update by the Infectious Diseases Society of America
Kevin P. High,1 Suzanne F. Bradley,2,3,4 Stefan Gravenstein,5,6,7,8 David R. Mehr,9 Vincent J. Quagliarello,10 Chesley Richards,11,12 and Thomas T. Yoshikawa13,14
1 3

Section on InfectiousDiseases, Wake Forest University Health Sciences, Winston Salem, North Carolina; Divisions of 2Infectious Diseases and Geriatrics, Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Ann Arbor Healthcare System, and 4University of Michigan School of Medicine, Ann Arbor, Michigan; 5AMDA Foundation Research Network, 6Quality Partners of Rhode Island, and 7Division of Geriatricsand 8Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island; 9Curtis W. and Ann H Long Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia; 10Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; 11Division of Healthcare Quality Promotion, Centers for Disease Control andPrevention, and 12Division of Geriatric Medicine and Gerontology, Emory University School of Medicine, Atlanta, Georgia; and 13GRECC, Veterans Affairs Greater Los Angeles Healthcare System, and 14David Geffen School of Medicine, University of California–Los Angeles

Residents of long-term care facilities (LTCFs) are at great risk for infection. Most residents are older and have multiple comorbiditiesthat complicate recognition of infection; for example, typically defined fever is absent in more than one-half of LTCF residents with serious infection. Furthermore, LTCFs often do not have the on-site equipment or personnel to evaluate suspected infection in the fashion typically performed in acute care hospitals. In recognition of the differences between LTCFs and hospitals with regard to hosts andresources present, the Infectious Diseases Society of America first provided guidelines for evaluation of fever and infection in LTCF residents in 2000. The guideline presented here represents the second edition, updated by data generated over the intervening 8 years. It focuses on the typical elderly person institutionalized with multiple chronic comorbidities and functional disabilities (e.g., anursing home resident). Specific topic reviews and recommendations are provided with regard to what resources are typically available to evaluate suspected infection, what symptoms and signs suggest infection in a resident of an LTCF, who should initially evaluate the resident with suspected infection, what clinical evaluation should be performed, how LTCF staff can effectively communicate aboutpossible infection with clinicians, and what laboratory tests should be ordered. Finally, a general outline of how a suspected outbreak of a specific infectious disease should be investigated in an LTCF is provided. EXECUTIVE SUMMARY By the year 2030, 20% of the United States population is estimated to be aged 65 years, and almost 30 million of these persons are anticipated to have functionallimitations that will increase the need for long-term care. Currently, there are 116,000 nursing homes/facilities for long-term care in the United States in which ∼1.5 million older adults reside. Care providers in long-term care facilities (LTCFs) are primarily nursing staff, and

Received 6 October 2008; accepted 6 October 2008; electronically published 11 December 2008. Reprints or correspondence:Dr. Kevin P. High, Sections on Infectious Diseases, Hematology/Oncology, and Molecular Medicine, Wake Forest University Health Sciences, 100 Medical Center Blvd., Winston Salem, NC 27157-1042 (khigh @wfubmc.edu). Clinical Infectious Diseases 2009; 48:149–71 2008 by the Infectious Diseases Society of America. All rights reserved. 1058-4838/2009/4802-0001$15.00 DOI: 10.1086/595683

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