What is the value of diagnostic tests at presentation in the ambulatory care setting to identify serious bacterial infections in the elderly? A systematic review and meta-analysis

Diagnostic tests for Diagnosis of Serious Bacterial Infections in the Elderly

With age, the immune system, which helps to fight infection, becomes less effective, making older people more susceptible to infections. Whilst people aged over 65 years make up around one in six of the population, they account for one in three outpatient attendances (that is, attendances to medical settings outside of hospital, such as GP practices).

Bacterial infections (such as urine, skin and chest infections) in older people can cause significant ill health. If not treated quickly, the infection can spread to the bloodstream, causing a widespread infection called septicaemia. Furthermore, these infections often present in an unusual fashion in older adults. Confusion and falls, rather than pain on passing urine, may be the only signs of serious urine infection.

As such, clinicians may request tests, such as blood or urine tests, to aid the diagnostic process. However, some studies have shown that these tests may not be as accurate in older people as they are in the young. There is limited official guidance to help clinicians in deciding which tests are best placed to help diagnose older patients with serious bacterial infections.

The aim of this review is to determine the diagnostic tests that are most likely to help diagnose serious bacterial infections in the elderly. We will look at studies that have investigated older patients with different bacterial infections in the outpatient setting, and determine how well different tests were found to predict these infections. By assessing and pooling the results, we hope to be able to give clear guidance to clinicians, equipping them with the knowledge of the most useful tests to use when assessing older adults for bacterial infections. 

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