ABSTRACT
A frequent feature in the frail elderly is the absence of significant pyrexia despite serious systemic bacterial infection. Occasionally, patients may even demonstrate hypothermia due to tissue hypo-perfusion. The commonest sources of infection are respiratory, genitourinary tract, gastrointestinal and skin, soft tissue or bone. Once the causative organism has been identified it may be possible to switch to a narrower-spectrum drug. In cases of milder infections it may be possible to obtain relevant culture results before prescribing treatment. Blood tests should include serum WCC and C-reactive protein as markers of an infective process. The initial treatment of severe infections includes early iv fluids, monitoring of urine output, obtaining appropriate cultures and giving iv broad-spectrum antibiotics within 1 hour. Gastric contents are typically considered sterile due to the high acidity. However, this is unlikely to be the case in older adults on acid-suppressing medications or those with atrophic gastritis.
