Following a first male urinary tract infection (mUTI), systematic investigation for predisposing factors is called for, as mUTIs frequently arise secondarily to anatomical or functional urinary tract abnormalities. Although no international consensus defines a minimal etiological work-up, guidelines from the French (AFU) and European (EAU) Associations of Urology provide a clinical framework. First-line assessment comprises a targeted history (laying emphasis on macroscopic hematuria and lower urinary tract symptoms, LUTS), digital rectal examination (DRE), the International Prostate Symptom Score (IPSS), and urinary tract ultrasonography with post-void residual (PVR) measurement. LUTS, classified as storage (urgency, frequency), voiding (weak stream, straining), or post-micturition (incomplete emptying) may indicate benign prostatic hyperplasia (BPH), the leading aetiology in men over 50. Ultrasound evaluates prostate volume, bladder morphology, and PVR; voiding diaries complement assessment when storage LUTS predominate. Alpha-blockers represent first-line therapy for BPH-related LUTS. Routine PSA testing following mUTI is not recommended, as elevations are non-specific: prostatitis may raise PSA independently of malignancy, and levels can remain elevated up to three months post-infection. No association exists between a first mUTI and prostate cancer, nor between PSA and UTI recurrence. Second-line referral is indicated for pyelonephritis, urinary retention, macroscopic hematuria, IPSS >7, PVR >100 mL, recurrent UTI, age under 40, or imaging abnormalities. Cross-sectional imaging (CT or MRI) is reserved for suspected obstruction, severe presentations, or treatment failure. This stratified approach optimizes cost-effectiveness, ensuring identification of underlying pathology (BPH, urolithiasis, or malignancy) while avoiding unnecessary investigations.

Management of Infective Endocarditis (IE) is complex. This study aimed to describe compliance with the ESC 2015 guidelines of first-line antibiotic therapy in real life in older people. In this observational, longitudinal, retrospective, national-based, real-life cohort involving 34 French hospitals, we included patients aged 75 years or older, admitted with a diagnosis of possible or definite IE. In total, 929 patients were included (mean age of 83 ± 5 years; Mean Charlson comorbidity score of 3 ± 2) and 294 patients had at least one prosthetic valve. Left-sided IE was most frequent (76.2%), of which 42.8% involved the aortic valve. The most identified pathogens were Staphylococcus spp (42.2%) and Streptococcus spp (38.2%). In total, 43.9% patients had a first-line antibiotic regimen non-compliant with guidelines. By multivariable analysis, the factors independently associated with non-compliance to recommendations for first-line antibiotic treatment were BMI ≥ 25 kg/m2, IE located on a native valve (aortic or mitral), and the presence of suspected healthcare-associated IE. Compliance did not differ fundamentally according to the publication year of guidelines (ESC 2015 versus ESC 2023). In conclusion, despite the robustness of the procedures for producing practice guidelines, compliance is low, probably because there are no specific guidelines for older people.

BACKGROUND:Amoxicillin/clavulanic acid (AMX/CLV) is commonly prescribed in older adults. Because oral and intravenous (IV) routes may be compromised by swallowing disorders or poor venous access, subcutaneous (SC) administration of AMX/CLV could be an alternative. The main objective of this study was to compare the bioavailability of AMX and CLV after IV and SC administration in older patients. PATIENTS AND METHODS:This prospective multicentre study enrolled patients aged over 65 y receiving SC or IV AMX/CLV (1 g/0.2 g/8 h). At steady state, AMX and CLV concentrations were measured just before and after the infusion, at 2 h (in the SC group only) and at 5 h using liquid chromatography coupled to tandem mass spectrometry. Population PK analysis estimated SC AMX/CLV bioavailability in comparison to IV administration and tolerance was assessed. RESULTS:Seventeen patients (mean age 85.1 ± 4.8 y) were enrolled (14 in the IV group and three in the SC group). SC bioavailability of AMX and CLV was estimated at 78% and 82%, respectively. Although Cmax values were ∼45% lower with SC administration, unbound AMX concentrations remained above thresholds for common pathogens (i.e. Streptococcus pneumoniae, Enterococci and Enterobacterales) and trough concentrations were close to those observed after IV administration. On the basis of safety assessment after 122 IV and SC infusions, no serious adverse event related to the treatment occurred and local SC adverse events were transient oedema, erythema and pain. CONCLUSIONS:The present study provides data supporting the use of SC administration of AMX/CLV in the older population.

The management of male urinary tract infections (UTIs) has historically been based on a monolithic approach, under which every episode was treated as acute prostatitis, leading to prolonged antibiotic courses. To address rising bacterial resistance and promote antimicrobial stewardship, the French Infectious Diseases Society (SPILF) updated its guidelines in 2026, introducing a stratified management framework. This review outlines the scientific evidence underlying these updated recommendations. A comprehensive review of recent literature, including randomized controlled trials and large-scale retrospective cohorts, was conducted so as to evaluate antibiotic efficacy, resistance patterns, and optimal treatment durations for male cystitis, febrile UTIs (prostatitis/pyelonephritis), and acute epididymo-orchitis. Evidence validates distinguishing male cystitis from febrile UTI. For male cystitis, 7-day regimens using narrow-spectrum oral agents-such as fosfomycin trometamol, nitrofurantoin, or pivmecillinam-achieve satisfactory clinical success with minimal risk of complications. Conversely, febrile UTIs require initial parenteral third-generation cephalosporins or oral fluoroquinolones. For targeted oral step-down therapy in prostatitis, cotrimoxazole is preferred over fluoroquinolones so as to minimize ecological impact, while amoxicillin remains the drug of choice for enterococcal coverage. Although recent data show that seven days can be sufficient for selected bacteremic presentations, to prevent relapses a conventional 14-day duration remains the standard for acute prostatitis. Non-sexually transmitted orchitis and epididymitis require a 10-day course of fluoroquinolones or cotrimoxazole. The 2026 SPILF guidelines represent a paradigm shift toward a tailored, stratified approach.

These guidelines address acute community-acquired urinary tract infections (UTIs) in adult men. The following situations are not covered: pediatric UTIs, UTIs in immunocompromised patients, catheter-associated UTIs (vesical, ureteral, or nephrostomy), neurogenic bladder, nosocomial UTIs, chronic and recurrent UTIs. This update defines nosological entities, including confirmation of the existence of cystitis in men. Definitions are provided in the first chapter. Epidemiological and bacterial resistance data specific to male UTIs-previously scarce and fragmented-are presented in the second chapter. Pharmacokinetic and pharmacodynamic data for antibiotics used in male UTIs are comprehensively reviewed and summarized in the third section. Treatment recommendations for each entity are detailed in the fourth chapter. The final chapter outlines investigations to be considered after UTI in men and situations requiring urological referral. This document presents a concise text, and brief supporting arguments regarding key points have been added. Four clinical vignettes summarizing the diagnosis and management of cystitis, pyelonephritis, and epididymo-orchitis are presented at the end of this recommendation (Figs. 1, 2, 3 and 4).

BACKGROUND:The association between infections and the functional independence of hospitalized older adults has not been extensively characterized. The objective of the present study was to evaluate the association between the occurrence of acute infections and loss of functional independence (LFI) in hospitalized older adults, taking into account previously identified risk factors. METHODS:This French multicentre, observational, prospective cohort study (NCT02949635) included patients aged ≥75 years hospitalized in an acute geriatric unit (AGU). Information on the presence of community-acquired or nosocomial infections and the infection site was collected. The patients' functional independence (according to the Katz Index) was assessed one month before admission to hospital, on admission to the AGU, and on discharge from the AGU. A logistic regression model was used to determine the factors associated with LFI, after adjustment for morbidity and geriatric syndromes. FINDINGS:Of the 3076 included patients (mean (standard deviation) age: 86.4 years (5.4)), 772 (23.7%) had a community-acquired infection, and 154 (5.1%) had a nosocomial infection. In a multivariate analysis, the presence of a community-acquired infection significantly increased the risk of LFI between admission and discharge (odds ratio (OR (95% confidence interval (CI): 1.34 (1.06-1.69)), after adjustment for conventional geriatric comorbidities such as cognitive impairment, malnutrition, and overall comorbidity burden. Only the need for walking assistance (OR: 1.39 (95% CI: 1.17-1.67)) and the length of hospital stay (1.01 (95% CI: 1.01-1.02)) were significantly associated with the risk of LFI. CONCLUSION:The risk of LFI was significantly higher in hospitalized older adults with an acute infection. Particular attention must be paid to maintaining these patients' functional independence as soon as an infection is identified.

Pneumocystis pneumonia (PCP) is well-described in younger and HIV-infected populations, but limited data are available for older non-HIV-infected patients. The aim was to describe the clinical characteristics, management and outcomes of PCP in older non-HIV-infected patients and to identify factors associated with in-hospital mortality. This multicentre, retrospective, cohort study included patients aged ≥ 75 years, hospitalised for non-HIV-related PCP in 12 French university hospitals between January, 2010 and December, 2021. PCP diagnosis was confirmed by PCR or microscopy. Data on demographics, comorbidities, clinical features, management and outcomes were collected. Factors associated with in-hospital mortality were identified by univariate and multivariate analysis. A total of 175 patients were screened and 162 were included (median age: 79 years, 57.4

Ceftriaxone is frequently administered subcutaneously in France, especially in older patients, although this practice is currently off-label. This work aims to describe the pharmacokinetics (PK) and pharmacodynamics (PD) and tolerance of ceftriaxone administered by intravenous and subcutaneous routes in older patients. Patients aged ≥65 years receiving intravenous or subcutaneous ceftriaxone 1 g every 24 hours were included. Steady-state plasma concentrations of ceftriaxone were measured. Based on intravenous and subcutaneous ceftriaxone concentrations and 24-hour area under the concentration-time curve (AUC), a population PK model was developed for probability of target attainment (PTA) analysis. Local and systemic adverse events (AEs) were collected. Data from 47 patients (24 in subcutaneous and 23 in intravenous groups) were analyzed. No between-group difference was observed in demographic and biological characteristics, ceftriaxone trough concentrations, or AUC. Bioavailability of subcutaneous ceftriaxone was estimated at 99% by population modeling. The PTA associated with subcutaneous administration were similar to or slightly better than that of the intravenous route. A dosing regimen of 1 or 2 g every 24 hours was associated with acceptable PTA and a low risk of overexposure in patients with normal or moderately altered renal function. Tolerance was assessed on 149 infusions (67 intravenous and 82 subcutaneous). One local AE (1.5%) was reported in the intravenous group versus 11 local AEs (mainly edema) in the subcutaneous group (13%), all transient and nonsevere. Subcutaneous administration of ceftriaxone was associated with PK/PD and dosage requirements comparable to those of intravenous administration, supporting the use of subcutaneous ceftriaxone in older patients.

INTRODUCTION:Pneumonia is a common occurrence at the end of life (EOL). However, clear definitions and consensual guidelines for managing this condition are lacking. Diagnosing EOL pneumonia and deciding whether to treat it with antibiotics can be challenging. AREA COVERED:This special report provides a narrative review of epidemiological data, diagnostic tools for EOL pneumonia, guidance on antibiotic use, and ethical considerations in this context. Literature from 2000 to 2024 was analyzed using PubMed and Cochrane databases. EXPERT OPINION:At the EOL, respiratory symptoms must be managed to improve patients' quality of life. Bacterial pneumonia can be difficult to diagnose, and the benefits of antibiotics on respiratory symptoms remain uncertain. At an individual level, adverse events may impact EOL quality, while at a population level, overprescribing antibiotics contributes to antimicrobial resistance. A multidisciplinary approach is therefore essential. Treatment goals should be established with the patient or their healthcare representative. If antibiotics are prescribed, they should be initiated for a limited duration with daily reassessments. If the set goals are not achieved or if adverse events occur, antibiotics should be discontinued. Palliative care measures should also be introduced as early as possible.

INTRODUCTION:The incidence of tuberculosis (TB) remains high in elderly adults in France. Immunosenescence and comorbidities challenge both diagnosis and treatment in this population. Recent data describing TB characteristics and outcomes in the elderlies are scarce. We aimed to describe clinical and microbiological features of TB in the elderly population and to identify factors associated with 2-year mortality. PATIENTS AND METHODS:We conducted a retrospective multicenter study including patients aged ≥ 75 years who were diagnosed with TB between 2010 and 2020 across 18 centers. A multivariate analysis was used to identify factors independently associated with 2-year mortality. RESULTS:A total of 295 patients were included: mainly born in France (57%). Immunosuppression was rare (9.8%). Fever and cough were uncommon, while weight loss was the most frequent symptom (60.3%), significantly associated with diagnostic delays. Pulmonary TB was the predominant form (63.1%) with higher culture positivity observed in this group and in the oldest patients. Isoniazid resistance was rare (5.2%). Standard quadritherapy was the most common initial regimen and was not associated with higher rates of adverse events. At two-year follow-up, overall mortality was 31.3%. In multivariate analysis, mortality was significantly associated with severe renal failure, living in nursing home or long-term care facilities, and weight loss at presentation. CONCLUSION:This study highlights the atypical presentation of TB in elderly adults and the continued use of standard quadritherapy despite low drug resistance. Weight loss, though nonspecific, appears to be the most prognostic symptom and is associated with delayed diagnosis and higher mortality.

BACKGROUND:Staphylococcus aureus bloodstream infection is treated with at least 14 days of intravenous antimicrobials. We assessed the efficacy and safety of an early switch to oral therapy in patients at low risk for complications related to S aureus bloodstream infection. METHODS:In this international, open-label, randomised, controlled, non-inferiority trial done in 31 tertiary care hospitals in Germany, France, the Netherlands, and Spain, adult patients with low-risk S aureus bloodstream infection were randomly assigned after 5-7 days of intravenous antimicrobial therapy to oral antimicrobial therapy or to continue intravenous standard therapy. Randomisation was done via a central web-based system, using permuted blocks of varying length, and stratified by study centre. The main exclusion criteria were signs and symptoms of complicated S aureus bloodstream infection, non-removable foreign devices, and severe comorbidity. The composite primary endpoint was the occurrence of any complication related to S aureus bloodstream infection (relapsing S aureus bloodstream infection, deep-seated infection, and mortality attributable to infection) within 90 days, assessed in the intention-to-treat population by clinical assessors who were masked to treatment assignment. Adverse events were assessed in all participants who received at least one dose of study medication (safety population). Due to slow recruitment, the scientific advisory committee decided on Jan 15, 2018, to stop the trial after 215 participants were randomly assigned (planned sample size was 430 participants) and to convert the planned interim analysis into the final analysis. The decision was taken without knowledge of outcome data, at a time when 126 participants were enrolled. The new sample size accommodated a non-inferiority margin of 10%; to claim non-inferiority, the upper bound of the 95% CI for the treatment difference (stratified by centre) had to be below 10 percentage points. The trial is closed to recruitment and is registered with ClinicalTrials.gov (NCT01792804), the German Clinical trials register (DRKS00004741), and EudraCT (2013-000577-77). FINDINGS:Of 5063 patients with S aureus bloodstream infection assessed for eligibility, 213 were randomly assigned to switch to oral therapy (n=108) or to continue intravenous therapy (n=105). Mean age was 63·5 (SD 17·2) years and 148 (69%) participants were male and 65 (31%) were female. In the oral switch group, 14 (13%) participants met the primary endpoint versus 13 (12%) in the intravenous group, with a treatment difference of 0·7 percentage points (95% CI -7·8 to 9·1; p=0·013). In the oral switch group, 36 (34%) of 107 participants in the safety population had at least one serious adverse event compared with 27 (26%) of 103 participants in the intravenous group (p=0·29). INTERPRETATION:Oral switch antimicrobial therapy was non-inferior to intravenous standard therapy in participants with low-risk S aureus bloodstream infection. However, it is necessary to carefully assess patients for signs and symptoms of complicated S aureus bloodstream infection at the time of presentation and thereafter before considering early oral switch therapy. FUNDING:Deutsche Forschungsgemeinschaft. TRANSLATIONS:For the German, Spanish, French and Dutch translations of the abstract see Supplementary Materials section.

IntroductionLa dalbavancine est un antibiotique actif sur les bactéries à CG+ qui possède une 1/2 vie très prolongée. Elle présente de plus l'avantage de ne pas avoir de toxicité ni d'interaction médicamenteuse notable. Son utilisation chez les patients âgés pourrait donc simplifier la prise en charge des infections graves à CG+ en limitant la iatrogénie. L'objectif de cette étude a été d'identifier les déterminants de la prescription de dalbavancine plutôt qu'un antibiotique conventionnel par les médecins.Matériels et méthodesNeuf critères de prescription ont été définis pour usage de la dalbavancine dans les infections graves documentées à CG+ chez les sujets >75 ans. Un questionnaire a été envoyé à un réseau d'infectiologues et de gériatres français leur demandant de noter ces critères entre 1 et 9 par ordre d'influence sur leur prescription, 1 correspondant à l'influence la plus faible et 9 à la plus élevée. Les modalités d'utilisation de la dalbavancine en pratique courante par les prescripteurs interrogés ont également été recueillies.RésultatsLa population de l'étude comporte 88 participants, dont 59% d'infectiologues et 39% de gériatres. Les critères d'utilisation de la dalbavancine prédominant sont l'accès à une voie veineuse difficile, la voie orale impossible et la présence de troubles du comportement avec une note moyenne de 6.5, 6 et 6.4. Les médecins prescrivent la dalbavancine lorsqu'au moins 2 critères sont combinés dans 75%. Les gériatres attribuent des notes plus élevées aux critères que les infectiologues, significativement pour 5 critères : présence de traitement à risque d'interaction médicamenteuse, polymédication, nécessité d'une reprise fonctionnelle rapide, dénutrition sévère et l'accès difficile à un plateau technique. 60% utilisent la dalbavancine dans leur pratique: les infections de la peau et des tissus mous our 15%, contre 62% qui l'utilisent pour traiter les endocardites infectieuses, 61% pour les infections ostéoarticulaires sur matériel et 52% sur os natif, 43% pour les infections endovasculaires, 37% pour les bactériémies et 19% pour les infections sur cathéter. Le coût financier représente un frein pour 57% des médecins et le manque d'expérience pour 46%. Les schémas de prescription sont variés, avec une prédominance du schéma par 2 perfusions de 1500 mg espacées de 15 jours, utilisé par 39% des médecins. Les autres schémas, d'une perfusion unique de 1500mg, de deux perfusions de 1500mg espacées de 7 jours et 2 perfusions de 1000mg puis 500mg espacées de 7 jours sont utilisés par 26%, 17% et 18%.ConclusionSi le profil pharmacocinétique et les données de tolérance de la dalbavancine en font un médicament de choix, l'utilisation reste limitée à des problématiques de voie d'administration et de simplification de prise en soin si le patient combine plusieurs critères gériatriques. Des études cliniques et médico-économiques sont nécessaires pour confirmer son intérêt en 1ere intention dans les nfections documentées.Aucun lien d'intérêt

Objectives: Lyme borreliosis incidence is increasing in several areas; moreover, it has recently gained the public's attention. Apart from erythema migrans, Lyme disease diagnosis relies (among others) on serology test; however, the prevalence of positive enzyme-linked immunosorbent assay (ELISA) and western blot (WB) assay has been poorly studied in the general population. We aimed to approach the seroprevalence of infection by Borrelia species responsible for Lyme disease in the French Isere department using city laboratories data. Patients and Methods: We retrieved all serological tests for Borrelia species responsible for Lyme disease performed in the two main networks of city laboratories between 2015 and 2020. All patients with both ELISA and WB IgG were considered seropositive. Results: We analyzed 27,360 tests (ELISA/ELISA+WB). Mean age was 50.9 +/- 20.3 years (ranges: 0-101), with 57.1% females. Overall, 11.7% had IgG detected by ELISA, and 4.7% had IgG detected by both ELISA and WB assay. Seropositive status was more frequent in males (7.0% vs. 2.9%, p < 0.001). Seropositivity rate increased with age after a first peak in childhood; men aged 61-70 years had the highest seropositivity rate (10.3%). In addition, seropositivity rate was higher in persons from a rural area. In multivariate analysis, older age, male gender and living in a rural area were independently associated with seropositivity. Seropositivity rate was stable on the 2017-2020 period. Conclusion: The seroprevalence of infection by Borrelia species responsible for Lyme disease is high in Isere; this probably reduces the predictive positive value for Lyme disease of ELISA and WB IgG, suggesting that this serological test should not be performed for nonspecific symptoms.

Background: In geriatrics, explicit criteria for potentially inappropriate prescriptions (PIPs) are useful for optimizing drug use. Objective: To produce an expert consensus on explicit definitions of antibiotic-PIPs for hospitalized older patients. Methods: We conducted a Delphi survey involving French experts on antibiotic stewardship in hospital settings. During the survey’s rounds, the experts gave their opinion on each explicit definition, and could suggest new definitions. Definitions with a 1-to-9 Likert score of between 7 and 9 from at least 75% of the participants were adopted. The results were discussed during consensus meetings after each round. Results: Of the 155 invited experts, 128 (82.6%) participated in the whole survey: 59 (46%) infectious diseases specialists, 45 (35%) geriatricians, and 24 (19%) other specialists. In Round 1, 65 explicit definitions were adopted and 21 new definitions were suggested. In Round 2, 35 other explicit definitions were adopted. The results were validated during consensus meetings (with 44 participants after Round 1, and 54 after Round 2). Conclusions: The present study is the first to have provided a list of explicit definitions of potentially inappropriate antibiotic prescriptions for hospitalized older patients. It might help to disseminate key messages to prescribers and reduce inappropriate prescriptions of antibiotics.

IntroductionL'endocardite infectieuse est une pathologie sévère avec un pronostic sombre. Les recommandations européennes préconisent l'administration d'une antibiothérapie intraveineuse à fortes doses de longue durée sans adaptation pour les sujets âgés. Pallotto et al ont démontré que ces schémas sont peu respectés en population adulte. ENDOLA avait pour objectif principal de comparer chez des sujets âgés de 75 ans et plus les schémas antibiotiques utilisés en vie réelle à ceux recommandés par l'ESC 2015.Matériels et méthodesEtude rétrospective multicentrique incluant les sujets de 75 ans et plus admis en hospitalisation avec un diagnostic d'endocardite infectieuse dans un des 30 centres français participant. Les données démographiques, biologiques, cliniques et les traitements antibiotiques reçus ont été collectés. Le statut vital à l'issue du séjour et la date de dernières nouvelles ont été récoltés. La conformité du traitement antibiotique reçu en première intention a été établie selon les recommandations de l'ESC 2015 (molécule prescrite ET durée totale de traitement selon identification du germe et nature de la valve concernée).RésultatsIl s'agit de résultats préliminaires, la fin des inclusions est prévue au 31 mars 2024 (238 inclusions au 29/01/2024). Au 01er septembre 2023, 122 patients étaient inclus (âge moyen 84.6 ± 5.3 ans ; 55% de femmes). Les germes les plus fréquemment documentés étaient le staphylocoque doré sensible à la méticilline dans les traitements non-conformes et le streptocoque sensible à la méticilline dans les traitements conformes. Le siège de l'endocardite le plus fréquent était la valve aortique. Au total, 50 % (n=61) des molécules anti-infectieuses prescrites en première intention après confirmation de l'agent en cause étaient conformes aux recommandations. La durée totale de traitement était conforme dans 66% (n=81) des cas. La conformité globale (molécule ET durée de traitement totale) était observée dans 36% (n=44) des cas. Concernant la survie à 12 mois, aucune différence statistiquement significative n'était observée entre les deux groupes de traitement (traitement globalement conforme versus traitement globalement non-conforme) (hazard ratio 1,63 (IC 95% 0,72-3,69)) (p =0,24). Dans l'analyse multivariée, le traitement globalement conforme (molécule ET durée de traitement totale) était associé uniquement avec l'absence de dépendance aux ADL (odds ratio 0,36 (IC95% 0,14-0,89)) (p=0,03). Le modèle avait une bonne discrimination (c-statistique = 0,72) et une bonne adéquation (p de Hosmer et Lemeshow = 0,16). Des analyses complémentaires seront réalisées sur l'ensemble de la cohorte.ConclusionDans cette cohorte observationnelle rétrospective, selon ces résultats préliminaires, moins d'un tiers de patients âgés de 75 ans ou plus admis pour une endocardite infectieuse a reçu un traitement antibiotique conforme aux recommandations (molécule prescrite et durée totale de traitement). La non-conformité du traitement prescrit en première intention n'était pas associée à une survie moins bonne en intra-hospitalier ni à 12 mois.Aucun lien d'intérêt

BACKGROUND:Infective endocarditis (IE) increasingly involves older patients. Geriatric status may influence diagnostic and therapeutic decisions. AIM:To describe transoesophageal echocardiography (TEE) use in elderly IE patients, and its impact on therapeutic management and mortality. METHODS:A multicentre prospective observational study (ELDERL-IE) included 120 patients aged ≥75 years with definite or possible IE: mean age 83.1±5.0; range 75-101 years; 56 females (46.7%). Patients had an initial comprehensive geriatric assessment, and 3-month and 1-year follow-up. Comparisons were made between patients who did or did not undergo TEE. RESULTS:Transthoracic echocardiography revealed IE-related abnormalities in 85 patients (70.8%). Only 77 patients (64.2%) had TEE. Patients without TEE were older (85.4±6.0 vs. 81.9±3.9 years; P=0.0011), had more comorbidities (Cumulative Illness Rating Scale-Geriatric score 17.9±7.8 vs. 12.8±6.7; P=0.0005), more often had no history of valvular disease (60.5% vs. 37.7%; P=0.0363), had a trend toward a higher Staphylococcus aureus infection rate (34.9% vs. 22.1%; P=0.13) and less often an abscess (4.7% vs. 22.1%; P=0.0122). Regarding the comprehensive geriatric assessment, patients without TEE had poorer functional, nutritional and cognitive statuses. Surgery was performed in 19 (15.8%) patients, all with TEE, was theoretically indicated but not performed in 15 (19.5%) patients with and 6 (14.0%) without TEE, and was not indicated in 43 (55.8%) patients with and 37 (86.0%) without TEE (P=0.0006). Mortality was significantly higher in patients without TEE. CONCLUSIONS:Despite similar IE features, surgical indication was less frequently recognized in patients without TEE, who less often had surgery and had a poorer prognosis. Cardiac lesions might have been underdiagnosed in the absence of TEE, hampering optimal therapeutic management. Advice of geriatricians should help cardiologists to better use TEE in elderly patients with suspected IE.