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Antibiotics
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Antibiotic Resistance in Geriatric Emergency Patients: Challenges and Strategies for...
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Antibiotic Resistance in Geriatric Emergency Patients: Challenges and Strategies for Optimal Management

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: 30 June 2026 | Viewed by 2340

Special Issue Editors

Dr. Sung Jin Bae

E-Mail Website
Guest Editor
Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
Interests: emergency medicine; geriatrics; frailty; sepsis; antibiotic stewardship; post-cardiac arrest syndrome; biomarkers; clinical prognosis prediction
Prof. Dr. Dong-Hoon Lee

E-Mail Website
Guest Editor
1. Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
2. Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea
Interests: geriatric emergency medicine; resuscitation; post-cardiac arrest care; primary emergency care

Special Issue Information

Dear Colleagues, 

Antibiotic resistance represents a growing global threat, and its impact is especially pronounced among geriatric patients presenting to emergency departments. Elderly patients often have multiple comorbidities, immunosenescence, and frequent prior antibiotic exposures, all of which contribute to colonization and infection with resistant organisms. In the fast-paced ED setting, early recognition of resistance patterns is critical for selecting appropriate empiric therapy and avoiding delays that can worsen outcomes. However, clinical decision tools and antibiograms tailored specifically to older adults remain limited. This Special Issue seeks original research and reviews that address epidemiology, diagnostic challenges, and management strategies for antibiotic-resistant infections in geriatric emergency patients. We welcome studies on rapid diagnostic approaches, stewardship interventions, pharmacokinetic/pharmacodynamic considerations in the elderly, and implementing age-adapted treatment guidelines. By bringing together clinical data, translational research, and practical recommendations, we will foster evidence-based practices that optimize antimicrobial use and improve prognosis in this vulnerable population.

Dr. Sung Jin Bae
Prof. Dr. Dong-Hoon Lee
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • antibiotic resistance
  • geriatric emergency medicine
  • antimicrobial stewardship
  • multidrug-resistant organisms

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Published Papers (3 papers)

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Research

12 pages, 1378 KB  
Article
Impact of a Multimodal Infection Control Intervention on Central Line-Associated Bloodstream Infections in the ICU
by Hyemin Chung, Insoon Choi, Kye Won Choe, Moonsuk Bae, Joung Ha Park, Oh Joo Kweon and Min-Chul Kim
Antibiotics 2026, 15(5), 504; https://doi.org/10.3390/antibiotics15050504 - 18 May 2026
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Abstract
Background/Objectives: Central line-associated bloodstream infection (CLABSI) remains a major healthcare-associated infection in intensive care units (ICUs). This study evaluated changes in CLABSI incidence following the implementation of a multimodal infection control intervention in the ICU. Methods: We conducted a quasi-experimental study [...] Read more.
Background/Objectives: Central line-associated bloodstream infection (CLABSI) remains a major healthcare-associated infection in intensive care units (ICUs). This study evaluated changes in CLABSI incidence following the implementation of a multimodal infection control intervention in the ICU. Methods: We conducted a quasi-experimental study in the adult ICUs of a referral hospital from January 2023 to December 2025. The interventions included staff education, performance feedback, infection control-led rounds, optimization of catheter practices, and reinforcement of environmental hygiene. The primary outcome was CLABSI incidence per 1000 central line-days. An interrupted time-series analysis using segmented Poisson regression with robust standard errors was used to assess temporal trends. Results: A total of 17 CLABSI cases occurred during the pre-intervention period, and 25 during the post-intervention period. There was no significant difference in CLABSI incidence between the two periods (incidence rate ratio, 1.07; 95% confidence interval, 0.58–1.98). However, interrupted time-series analysis demonstrated a significant decreasing trend in CLABSI incidence following the intervention (rate ratio, 0.89 per month; 95% confidence interval, 0.81–0.97; p = 0.01). This trend was observed despite the higher patient severity and increased use of advanced supportive therapies in the post-intervention period. The device utilization ratio and monthly blood culture rate remained unchanged. Avoidance of femoral venous access increased, and adherence to catheter-handling protocols significantly improved. Conclusions: A staged, multimodal intervention was associated with a significant decreasing trend in CLABSI incidence over time, suggesting a potential benefit of comprehensive infection prevention strategies in ICU settings. Full article
(This article belongs to the Special Issue Antibiotic Resistance in Geriatric Emergency Patients: Challenges and Strategies for Optimal Management)
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17 pages, 636 KB  
Article
Association Between Clinical Frailty and Antibiotic Resistance Among Older Patients with Fever in the Emergency Department
by Ji Yeon Lim, Dong Hoon Lee, Ho Sub Chung, Yunhyung Choi, Yoon Hee Choi, Keon Kim, Ki-Hun Hong and Sung Jin Bae
Antibiotics 2026, 15(3), 296; https://doi.org/10.3390/antibiotics15030296 - 14 Mar 2026
Viewed by 694
Abstract
Background: Frailty may predispose older adults to antibiotic-resistant infections; however, evidence in emergency department (ED) patients with fever remains limited. Methods: We conducted a retrospective multicenter cohort study of 544 ED patients aged ≥65 years with fever (tympanic temperature ≥ 37.5 [...] Read more.
Background: Frailty may predispose older adults to antibiotic-resistant infections; however, evidence in emergency department (ED) patients with fever remains limited. Methods: We conducted a retrospective multicenter cohort study of 544 ED patients aged ≥65 years with fever (tympanic temperature ≥ 37.5 °C) between August and October 2023. The cohort included 234 men and 310 women. Frailty was assessed using the Clinical Frailty Scale (CFS) and categorized as robust (CFS 1–3), pre-frail (CFS 4–5), or frail (CFS 6–9). ED-initiated microbiological cultures were obtained in 329/544 (60.5%) patients. The primary outcome was the detection of antibiotic-resistant isolates among culture-tested patients. Results: Among culture-tested patients (n = 329), antibiotic-resistant isolates were detected in 65/329 (19.8%), with a graded increase across frailty strata: robust 13/121 (10.7%), pre-frail 16/88 (18.2%), and frail 36/120 (30.0%). In multivariable logistic regression restricted to culture-tested patients, frailty was independently associated with resistant infection (adjusted OR 2.84, 95% CI 1.15–7.04, p = 0.024). Frail patients also experienced greater therapeutic complexity, including higher rates of antibiotic regimen modification (68.1% vs. 54.5%) and longer antibiotic duration (median, 11 vs. 8 days), as well as worse clinical outcomes, including higher ICU admission (37.7% vs. 17.8%) and in-hospital mortality (7.2% vs. 1.8%) compared with robust patients. Conclusions: Frailty is independently associated with antibiotic-resistant infections in older ED patients with fever. Integrating frailty assessment into ED protocols can enhance risk stratification, inform empirical antibiotic selection, and antimicrobial stewardship strategies. Full article
(This article belongs to the Special Issue Antibiotic Resistance in Geriatric Emergency Patients: Challenges and Strategies for Optimal Management)
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11 pages, 1040 KB  
Article
Effects of Antibiotic Stewardship Program on Antibiotic Consumption and the Incidence of Clostridioides difficile Infection
by Joung Ha Park, Juhee Kim, Juyeon Lee, Hyemin Chung and Min-Chul Kim
Antibiotics 2026, 15(2), 112; https://doi.org/10.3390/antibiotics15020112 - 23 Jan 2026
Viewed by 840
Abstract
Background/Objectives: Growing concerns about antibiotic-associated adverse events, including Clostridioides difficile infection, prompted implementation of an antibiotic stewardship program (ASP) in South Korea in November 2024. One year post-implementation, we evaluated changes in antibiotic consumption and C. difficile infection incidence. Methods: This [...] Read more.
Background/Objectives: Growing concerns about antibiotic-associated adverse events, including Clostridioides difficile infection, prompted implementation of an antibiotic stewardship program (ASP) in South Korea in November 2024. One year post-implementation, we evaluated changes in antibiotic consumption and C. difficile infection incidence. Methods: This study was conducted at Chung-Ang University Gwangmyeong Hospital, South Korea. Segmented regression and interrupted time series analyses were performed using weekly data on antibiotic use (days of therapy [DOT] per 1000 patient-days) and C. difficile infection or colonization (cases per 1000 patient-days) over 157 weeks (November 2022–October 2025). Weeks 1–105 defined the pre-ASP period, and weeks 106–157 the post-ASP period. A 4-week lag between antibiotic use and subsequent C. difficile infection was hypothesized. Results: Before ASP, weekly total antibiotic use increased (β1 = 1.14, 95% CI, 0.76 to 1.51, p < 0.001). After ASP, the slope decreased significantly (β3 = −1.50, 95% CI −2.62 to −0.39, p = 0.009), consistent across anti-pseudomonal penicillins and cephalosporins and fluoroquinolones. Pre-ASP C. difficile incidence increased (α1 = 0.01, 95% CI, 0.01 to 0.02, p < 0.001); the upward trend attenuated post-ASP, though slope change was not significant (α3 = −0.01, 95% CI, −0.03 to 0.004, p = 0.13). An increase of 1 DOT per 1000 patient-days was associated with a 0.005-case increase in C. difficile infection incidence after 4 weeks. Conclusions: The observed effects of proactive ASP strategies underscore the importance of maintaining stewardship in clinical practice. Further studies are warranted to assess the sustainability of these findings and evaluate additional factors influencing C. difficile infection incidence. Full article
(This article belongs to the Special Issue Antibiotic Resistance in Geriatric Emergency Patients: Challenges and Strategies for Optimal Management)
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