TY - JOUR
T1 - Impact of age and comorbidity on cause and outcome in community-acquired pneumonia
AU - Cillóniz, Catia
AU - Polverino, Eva
AU - Ewig, Santiago
AU - Aliberti, Stefano
AU - Gabarrús, Albert
AU - Menéndez, Rosario
AU - Mensa, Josep
AU - Blasi, Francesco
AU - Torres, Antoni
N1 - Funding Information:
Author contributions: Dr Torres is the guarantor of the entire manuscript and is responsible for the content of the manuscript, including the data collection and analysis. Dr Cillóniz: contributed to the review of the study data; writing and editing of the main body of the manuscript; supervision of the collection of clinical, radiologic, and microbiologic data; and approval of the final manuscript. Dr Polverino: contributed to the supervision of the collection of clinical, radiologic, and microbiologic data and approved the final manuscript. Dr Ewig: contributed to the design of the project, analysis and interpretation of the results, and editing of the final manuscript. Mr Gabarrús: contributed to the statistical analysis of the study and review and approval of the final manuscript. Dr Aliberti: contributed to the design of the project and approval of the final manuscript. Dr Menéndez: contributed to the design of the project and approval of the final manuscript. Dr Mensa: contributed to the supervision of the collection of epidemiologic and microbiologic data and approval of the final manuscript. Dr Blasi: contributed to the design of the project, writing and editing of the main body of the manuscript, and review and approval of the final manuscript. Dr Torres: contributed to the leading of the study group, the design of the project, approval of the final manuscript, and is the guarantor of the entire manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article. Role of sponsors: CibeRes is an initiative of Carlos III Institute and provides early financial support to selected research groups. GRQ is an initiative of Generalitat of Catalunya and provides partial funding every 5 years for selected research groups. Additional information: The e-Tables can be found in the “Supplemental Materials” area of the online article.
PY - 2013/9
Y1 - 2013/9
N2 - 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 infl uence 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 infl uenzae, 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 infl uence microbial cause itself, whereas comorbidities are associated with specifi c causes such as H infl uenzae and potential MDR pathogens. Mortality in the elderly is mainly driven by the presence of comorbidities and potential MDR pathogens.
AB - 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 infl uence 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 infl uenzae, 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 infl uence microbial cause itself, whereas comorbidities are associated with specifi c causes such as H infl uenzae and potential MDR pathogens. Mortality in the elderly is mainly driven by the presence of comorbidities and potential MDR pathogens.
UR - http://www.scopus.com/inward/record.url?scp=84884328137&partnerID=8YFLogxK
U2 - 10.1378/chest.13-0062
DO - 10.1378/chest.13-0062
M3 - Original Article
C2 - 23670047
AN - SCOPUS:84884328137
SN - 0012-3692
VL - 144
SP - 999
EP - 1007
JO - Chest
JF - Chest
IS - 3
ER -
