Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment

Abstract

Community-acquired pneumonia remains a major cause of mortality in developed countries. There is much discrepancy in the literature regarding factors influencing the outcome in the elderly population.Data were derived from a multicentre prospective study initiated by the German Competence Network for Community-Acquired Pneumonia. Patients with community-acquired pneumonia (n52,647; 1,298 aged ,65 yrs and 1,349 aged o65 yrs) were evaluated, of whom 72.3% were hospitalised and 27.7% treated in the community. Clinical history, residence status, course of disease and antimicrobial treatment were prospectively documented. Microbiological investigations included cultures and PCR of respiratory samples and blood cultures. Factors related to mortality were included in multivariate analyses.The overall 30-day mortality was 6.3%. Elderly patients exhibited a significantly higher mortality rate that was independently associated with the following: age; residence status; confusion, urea, respiratory frequency and blood pressure (CURB) score; comorbid conditions; and failure of initial therapy. Increasing age remained predictive of death in the elderly. Nursing home residents showed a four-fold increased mortality rate and an increased rate of Gram-negative bacillary infections compared with patients dwelling in the community. The CURB score and cerebrovascular disease were confirmed as independent predictors of death in this subgroup.Age and residence status are independent risk factors for mortality after controlling for comorbid conditions and disease severity. Failure of initial therapy was the only modifiable prognostic factor.

Identification of new risk factors for pneumonia: population-based case-control study

“…13,14 Pneumonia is also the most common cause of death in patients with acute stroke, 15 and it occurs more frequently than expected in dementia patients, 7,16 and in patients with solid cancers. 11,17,18 Given the uncertainty regarding the effectiveness of pneumococcal vaccination, 19 and in the presence of increasing morbidity due to pneumonia, GPs need to be able to identify and closely monitor those patients at highest risk of pneumonia. For example, such patients might benefit from earlier intervention with antibiotics when they present to their GP with a chest infection.…”

Comparison of ampicillin-sulbactam/macrolide dual therapy versus fluoroquinolone monotherapy in hospitalized patients with community-acquired pneumonia

“…Kothe ve arkadaşlarının çalışmasında, ampirik olarak beta-laktam ± makrolid veya solunum florokinolonları başlanan hastalarda 65 yaş altı 1.298 hastanın %25.4'ünde ve 65 yaş üstü 1.349 hastanın %32.6'sında tedavi başarısızlığına bağlı başlangıç antibiyotik tedavisinde değişiklik yapılmıştır (24).…”

Adesão a diretrizes e impacto nos desfechos em pacientes hospitalizados por pneumonia adquirida na comunidade em um hospital universitário

“…Other authors have reported the association of comorbidities and guideline-discordant antibiotic therapy with mortality. (7,28) The present study has limitations, which should be pointed out. It is possible that the retrospective design contributed to the significant loss of information that might have changed the results obtained.…”