TUESDAY, Dec. 15, 2020 — Most older adult residents of nursing homes who have acute infection will manifest some localizing signs and symptoms of infection, according to updated clinical guidelines issued by the Society for Healthcare Epidemiology of America and published online Dec. 9 in Infection Control & Hospital Epidemiology.

Theresa A. Rowe, D.O., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues evaluated the clinical reliability of nonlocalized signs and symptoms as indicators of infection among residents of nursing homes.

The authors note that older adults may manifest acute illness with atypical signs and symptoms, including those that are nonlocalizing; however, some localizing signs and symptoms of infection will be exhibited by most nursing home residents with an acute infection. Symptoms that should prompt further evaluation for infection include fever, hypothermia, new-onset hypotension, new-onset hyperglycemia, and delirium. The possibility of noninfectious causes should also be considered. Symptoms that should not prompt further evaluation for infection include behavioral changes exclusive of delirium, which should prompt a formal delirium assessment but no further evaluation for infection; new-onset functional decline; falls; or new-onset anorexia.

“This guidance should not send the message that residents with certain nonspecific signs or symptoms can’t have an infection,” Rowe said in a statement. “They certainly can, especially with signs such as fever or delirium.”

Several authors disclosed financial ties to the pharmaceutical industry.

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