Data di Pubblicazione:
2013
Citazione:
Impact of age and comorbidity on cause
and outcome in community-acquired
pneumonia / C. Cillóniz, E. Polverino, S. Ewig, S. Aliberti, A. Gabarrús, R. Menéndez, J. Mensa, F. Blasi, A. Torres. - In: CHEST. - ISSN 0012-3692. - 144:3(2013), pp. 999-1007. [10.1378/chest.13-0062]
Abstract:
BACKGROUND:
Prolonged life expectancy has currently increased the proportion of the very elderly among patients with community-acquired pneumonia (CAP). The aim of this study was to determine the influence of age and comorbidity on microbial patterns in patients over 65 years of age with CAP.
METHODS:
This study was a prospective observational study of adult patients with CAP (excluding those in nursing homes) over a 12-year period. We compared patients aged 65 to 74 years, 75 to 84 years, and > 85 years for potential differences in clinical presentation, comorbidities, severity on admission, microbial investigations, causes, antimicrobial treatment, and outcomes.
RESULTS:
We studied a total of 2,149 patients: 759 patients (35.3%) aged 65 to 74 years, 941 patients (43.7%) aged 75 to 84 years, and 449 patients (20.8%) aged > 85 years. At least one comorbidity was present in 1,710 patients (79.6%). Streptococcus pneumoniae was the most frequent pathogen in all age groups, regardless of comorbidity. Staphylococcus aureus, Enterobacteriaceae, and Pseudomonas aeruginosa accounted for 9.1% of isolates, and Haemophilus influenzae, 6.4%. All these pathogens were isolated only in patients with at least one comorbidity. Mortality increased with age (65-74 years, 6.9%; 75-84 years, 8.9%; > 85 years, 17.1%; P < .001) and was associated with increased comorbidities (neurologic; OR, 2.1; 95% CI, 1.5-2.1), Pneumonia Severity Index IV or V (OR, 3.2; 95% CI, 1.8-6.0), bacteremia (OR, 1.7; 95% CI, 1.1-2.7), the presence of a potential multidrug-resistant (MDR) pathogen (S aureus, P aeruginosa, Enterobacteriaceae; OR, 2.4; 95% CI, 1.3-4.3), and ICU admission (OR, 4.2; 95% CI, 2.9-6.1) on multivariate analysis.
CONCLUSIONS:
Age does not influence microbial cause itself, whereas comorbidities are associated with specific causes such as H influenzae and potential MDR pathogens. Mortality in the elderly is mainly driven by the presence of comorbidities and potential MDR pathogens.
Tipologia IRIS:
01 - Articolo su periodico
Elenco autori:
C. Cillóniz, E. Polverino, S. Ewig, S. Aliberti, A. Gabarrús, R. Menéndez, J. Mensa, F. Blasi, A. Torres
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