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Antibiotics
Special Issues
Antimicrobial Stewardship in Older Adults
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Antimicrobial Stewardship in Older Adults

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 827

Special Issue Editor

Dr. Elisa Fabbri

E-Mail Website
Guest Editor
1. Division of Internal Medicine, Morgagni-Pierantoni Hospital Forlì, Forlì, Italy
2. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
Interests: multimorbidity; frailty; biology of aging; inflammation; geriatric medicine; cognition; cardiovascular diseases
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

As the population ages, more older adults are admitted to emergency departments with suspected infections. Early recognition and timely antimicrobial treatment remain difficult in this group. The effectiveness of clinical scores and biomarkers is uncertain. Frailty, multimorbidity, and polypharmacy further complicate management and worsen outcomes. Older adults also face a higher risk of multidrug-resistant infections, increasing treatment complexity. Frail and medically complex older adults are often underrepresented in clinical trials, highlighting the need for individualized care. I support this Special Issue, which will address these challenges and recent research in antimicrobial stewardship for older adults and aims to advance the current literature.

Dr. Elisa Fabbri
Guest Editor

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

  • antimicrobial stewardship
  • older adults
  • antimicrobial treatment

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Published Papers (2 papers)

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Review

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21 pages, 1874 KB  
Review
Sepsis in Frail Older Adults: Tailored Antimicrobial Stewardship and Individualized Care Approach
by Elisa Fabbri, Gianpiero Tebano, Arianna de Angelis, Annaviola Del Prete, Lorenzo Maestri, Francesco Cristini and Paolo Muratori
Antibiotics 2026, 15(5), 496; https://doi.org/10.3390/antibiotics15050496 - 14 May 2026
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Abstract
Frail older adults face an increased risk and severity of sepsis, which contributes to a notably high mortality rate. The management of sepsis in this population presents significant challenges, such as diagnostic complexity, a higher prevalence of multidrug-resistant pathogens, difficulties in achieving effective [...] Read more.
Frail older adults face an increased risk and severity of sepsis, which contributes to a notably high mortality rate. The management of sepsis in this population presents significant challenges, such as diagnostic complexity, a higher prevalence of multidrug-resistant pathogens, difficulties in achieving effective source control, and an increased risk of adverse events and toxicity associated with antibiotic therapy. In addition, accurate prognostic evaluation based on a comprehensive geriatric assessment is essential to determine the intensity of care required and to develop a personalized plan of care. Despite these considerations, frail older adults are still often underrepresented in randomized clinical trials and guidelines. In this narrative review, we discuss the main pillars of tailored antimicrobial stewardship in frail older adults. We propose a practical, stepwise approach to individualized care, delivered by a multidisciplinary team and based on a careful balance between treatment intensity and patients’ vulnerabilities, needs, and priorities. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship in Older Adults)
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Other

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18 pages, 778 KB  
Systematic Review
Exploring the Link Between RSV Infection and Antibiotic Prescriptions in Older Adults: A Systematic Review
by Farzaneh Eslami, Priscilla Anyimiah, Sjoukje van der Werf, Maarten J. Postma and Cornelis Boersma
Antibiotics 2026, 15(5), 514; https://doi.org/10.3390/antibiotics15050514 - 19 May 2026
Abstract
Background/Objective: Respiratory syncytial virus (RSV) is an often under-recognized cause of respiratory illness in older adults. Clinical overlap with bacterial infections and delayed virologic confirmation may lead to the unnecessary prescription of antibiotics and antimicrobial resistance (AMR). This systematic review was conducted to [...] Read more.
Background/Objective: Respiratory syncytial virus (RSV) is an often under-recognized cause of respiratory illness in older adults. Clinical overlap with bacterial infections and delayed virologic confirmation may lead to the unnecessary prescription of antibiotics and antimicrobial resistance (AMR). This systematic review was conducted to assess antibiotic prescription in older adults with RSV and the factors influencing these decisions. Methods: This systematic review was preregistered in PROSPERO (CRD42024586905) and reported according to PRISMA guidelines. PubMed/MEDLINE, Embase, Web of Science, Cochrane CENTRAL, and Scopus were searched for studies published between January 2000 and August 2025. Eligible studies were those including adults aged ≥60 or ≥65 years with RSV infection and reporting antibiotic use. Data on antibiotic prescription, confirmed bacterial infection, hospitalization, length of stay (LOS), and prescribing indications were extracted. Results: Eight observational studies across inpatient, outpatient, emergency, and primary-care settings were included. Antibiotic prescribing ranged from 40.0% to 97.7%, whereas confirmed bacterial infection did not exceed 20% in any study. Antibiotic prescribing was associated with diagnostic uncertainty, radiologic findings, inflammatory markers, respiratory distress, delayed RSV testing, and multimorbidity rather than microbiological confirmation. Hospitalization rates varied across settings, and the LOS ranged from 3.5 to 11 days. None of the studies reported antibiotic discontinuation following RSV confirmation. Conclusions: Older adults with RSV frequently receive antibiotics despite low rates of confirmed bacterial infection, indicating substantial empirical prescribing. Improved rapid diagnostics, reassessment of therapy, and strengthened antimicrobial stewardship may help reduce unnecessary antibiotic use. RSV vaccination may be a promising strategy for reducing severe disease and hospitalization, with a potential indirect effect on antibiotic use, although these effects remain hypothetical. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship in Older Adults)
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