Antibiotic Resistance in the Elderly: Mechanisms, Risk Factors, and Solutions

Abstract

Antibiotic resistance presents a critical challenge in healthcare, particularly among the elderly, where multidrug-resistant organisms (MDROs) contribute to increased morbidity, mortality, and healthcare costs. This review focuses on the mechanisms underlying resistance in key bacterial pathogens and highlights how aging-related factors like immunosenescence, frailty, and multimorbidity increase the burden of infections from MDROs in this population. Novel strategies to mitigate resistance include the development of next-generation antibiotics like teixobactin and cefiderocol, innovative therapies such as bacteriophage therapy and antivirulence treatments, and the implementation of antimicrobial stewardship programs to optimize antibiotic use. Furthermore, advanced molecular diagnostic techniques, including nucleic acid amplification tests and next-generation sequencing, allow for faster and more precise identification of resistant pathogens. Vaccine development, particularly through innovative approaches like multi-epitope vaccines and nanoparticle-based platforms, holds promise in preventing MDRO infections among the elderly. The role of machine learning (ML) in predicting resistance patterns and aiding in vaccine and antibiotic development is also explored, offering promising solutions for personalized treatment and prevention strategies in the elderly. By integrating cutting-edge diagnostics, therapeutic innovations, and ML-based approaches, this review underscores the importance of multidisciplinary efforts to address the global challenge of antibiotic resistance in aging populations.

Keywords: aging; antibiotic resistance; antimicrobial stewardship; antimicrobials; elderly; immunosenescence; infectious diseases; machine learning; multidrug-resistant organisms; vaccinations.

Figure 1

Median Prevalence of MDROs Among Elderly Residents in LTCFs. Abbreviations. CRE (carbapenem-resistant Enterobacteriaceae); ESBL (extended-spectrum β-lactamase); LTCFs (long-term care facilities); MDROs (multidrug-resistant organisms); MRSA (methicillin-resistant Staphylococcus aureus); VRE (vancomycin-resistant Enterococcus).