A hospital study of community acquired pneumonia in the elderly.

Venkatesan, Pradhib; Gladman, John; Macfarlane, J T; Barer, David; Berman, Peter H.; Kinnear, William; Finch, Roger

doi:10.1136/thx.45.4.254

Cited by 218 publications

(141 citation statements)

References 11 publications

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“…Venkatesan and coworkers [18] and Harper and associates found a prevalence of 47% and 15%, respectively, of mental alteration in elderly patients with CAP at admission. A practical conclusion of clinical interest is that an effort has to be made to take chest radiographs, upon arrival at the hospital, of all elderly patients with delirium.…”

Section: Predisposing Conditionsmentioning

confidence: 99%

“…The incomplete clinical picture of CAP in the elderly may be associated with a delay in establishing the diagnosis and, consequently, in starting adequate antibiotic therapy. Delay in diagnosis and treatment may contribute to the higher observed death rate in the elderly population with CAP [9,10]. Hence the following study was undertaken to study the clinical, radiological, and bacteriological profile of community-acquired pneumonia in elderly.…”

Section: Introductionmentioning

confidence: 99%

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A Study of Community-Acquired Pneumonias in Elderly Individuals in Bijapur, India

et al. 2012

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Community-acquired pneumonia (CAP) in elderly has different clinical presentation and higher mortality than CAP in other age group. Clinical presentation may vary from mere presence of fever to altered sensorium. The incomplete clinical picture of CAP in the elderly may be associated with a delay in establishing the diagnosis and, consequently, in starting adequate antibiotic therapy. Delay in diagnosis and treatment may contribute to the higher observed death rate in the elderly population with CAP. Hence the following study was undertaken to study the clinical, radiological, and bacteriological profile of community-acquired pneumonia in elderly. A total of 50 patients were studied. Age group varied from 66 years to 88 years. Presentation varied from typical symptoms to altered sensorium. Smoking and COPD were most common predisposing conditions. Most common organisms responsible were Streptococcus pneumonia, Klebsiella pneumonia, Pseudomonas, H. influenza, and Staphylococcus aureus. Etiological agents could not be identified in many cases because of difficulty in collecting sputum in elderly patients, lower yield of culture, and various atypical and difficult to isolate causative organisms. Hence there is need for an empirical therapy covering both typical and atypical organisms. Better understanding of these aspects may help a long way in managing elderly patients with pneumonia.

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Section: Predisposing Conditionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Study of Community-Acquired Pneumonias in Elderly Individuals in Bijapur, India

et al. 2012

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“…With an incidence of up to 30 cases per 1,000 inhabitants per year [1] and a mortality rate of 26±33% [2,3], community-acquired pneumonia in the elderly remains a serious healthcare problem. This is even more true when demographic projections implying an increasing proportion of elderly persons in the general population are taken into account.…”

mentioning

confidence: 99%

Clinical significance of MCP-1 levels in BALF and serum in patients with interstitial lung diseases

Suga¹,

Iyonaga²,

Ichiyasu³

et al. 1999

European Respiratory Journal

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The aim of the study was to validate the prediction rule of M.J. Fine and coworkers for clinical outcome variables and three prognostic rules for the individual outcome of community-acquired pneumonia in an elderly population (rule 1: respiratory frequency $30 breaths . min -1 , diastolic blood pressure #60 mmHg, blood urea nitrogen >7 mM; rule 2: respiratory frequency $30 breaths . min -1 , diastolic blood pressure #60 mmHg, mental confusion; and rule 3: systolic blood pressure #80 mmHg, cardiac frequency $90 beats . min -1 , lactate dehydrogenase activity $260 IU . L -1 ; death was predicted in the presence of at least two of three parameters). Overall 168 consecutive episodes of community-acquired pneumonia in patients aged $65 yrs and hospitalized in a primary care hospital were studied prospectively.Fine's rule was tested for its ability to predict length of hospital stay, requirement for intensive care unit (ICU) admission and death. For the three prognostic rules of individual outcome, performance regarding predicting death was determined.Mortality was 17/168 (10%). Fine's rule accurately predicted length of stay, the requirement for ICU admission and the risk of death from pneumonia as compared to the original derivation and validation cohorts. All three rules achieved moderate-tohigh specificity (73%, 88% and 80%, respectively) and high negative predictive values (95%, 94% and 93%, respectively) but had a low sensitivity (65%, 47% and 47%, respectively). Rule 2 most closely reflected the risk of death from pneumonia when Fine's classification was used as reference.Fine's rule proved to give valid estimations regarding clinical outcome variables of community-acquired pneumonia in the elderly. The prognostic rules may be useful in determining individual patients at lower risk of death caused by pneumonia.

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“…Firstly rapid results which can direct initial antibiotic therapy will be useful for patients admitted to hospital with severe pneumonia and who run the risk of mortality rates of 6-30 % [9,10]. Secondly in performing studies, specific diagnosis will help in accruing sufficient numbers of documented pneumococcal pneumonias to achieve statistical significance, which has proved difficult in the past for example in relation to pneumococcal vaccine studies [ 1].…”

Section: Introductionmentioning

confidence: 99%

Oropharyngeal production of pneumococcal capsular antigen and the potential for contamination of expectorated sputum samples in pneumococcal pneumonia

et al. 1993

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SUMMARYThe presence of pneumococcal capsular antigen (PCA) in the oropharynx was sought in subjects without respiratory tract infection. Saliva specimens from 239 subjects were analysed by counter-current immunoelectrophoresis using 'Omniserum'. 15 5% gave positive reactions but only 24% of positive samples were typable and therefore due to pneumococcal or pneumococcal-like antigens. Given that oropharyngeal production of antigens occurs we investigated whether PCA in expectorated sputum arose from oropharyngeal contamination. Sixteen patients with pneumococcal pneumonia, and with sputum positive for PCA, were investigated in detail. On the basis of serotyping and concentration the PCA in sputum was thought to arise from the lower respiratory tract in all cases. This was confirmed by a simple, novel approach involving the comparison of concentrations in concomitant samples of saliva and sputum. Thus while oropharyngeal production of antigens poses a potential diagnostic problem the latter approach can be used to exclude contamination.

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A hospital study of community acquired pneumonia in the elderly.

Abstract: The aetiology of community acquired pneumonia in the elderly in Britain has not been reported, and we have therefore studied the cause and outcome of pneumonia in elderly patients admitted to a district general hospital prospectively over a six month period.

Cited by 218 publications

References 11 publications

A Study of Community-Acquired Pneumonias in Elderly Individuals in Bijapur, India

A Study of Community-Acquired Pneumonias in Elderly Individuals in Bijapur, India

Clinical significance of MCP-1 levels in BALF and serum in patients with interstitial lung diseases

Oropharyngeal production of pneumococcal capsular antigen and the potential for contamination of expectorated sputum samples in pneumococcal pneumonia

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