Community-Acquired Pneumonia In The Elderly: Every Tenth Patient Dies In Western Countries

Main Category: Respiratory / Asthma
Also Included In: Seniors / Aging;  Infectious Diseases / Bacteria / Viruses
Article Date: 30 Jun 2008 - 3:00 PDT

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Community-acquired pneumonia (CAP) represents a public health problem of substantial magnitude, and remains the leading cause of death due to infectious diseases, with an incidence ranging from 1.6 to 10.6 per 1,000 adults per year in Europe.

Owing to demographic changes, elderly patients now represent about 50% of CAP patients in western countries.

Considering that there is much discrepancy in the literature regarding factors influencing the outcome in this subgroup, a prospective study undertaken by Henning Kothe (University of Lübeck, Germany) and his colleagues was conducted to assess the prognostic factors of CAP with a special emphasis on age, residence status, comorbidities and antimicrobial treatment. The data were derived from a multicentre cohort study initiated by the German Competence network for CAP (CAPNETZ; http://www.capnetz.de), which includes 10 clinical centres (hospitals and outpatient facilities from all levels of healthcare).

The authors evaluated 2,647 patients (1,298 < 65 years, 1,349 > 65 years) with CAP. A total of 72.3% were hospitalised, and 27.7% were treated in the community. Clinical history, residence status, course of disease, microbiological findings and antimicrobial treatment were prospectively documented. Factors related to mortality were included in multivariate analysis.

The study shows that 30-day mortality is 6.3% and that elderly patients have a significantly higher mortality rate (10.3% in patients >65 years old).

The following factors are independently associated with death: age, living in a nursing home, the CURB severity score, comorbidities and failure of antibiotic therapy.

Nursing home residents have a four-fold increase in mortality rate, a higher CURB score and an increased rate of Gram-negative infections, when compared to community dwellers from the same age group.

The authors conclude that age and residence status are independent risk factors for mortality after controlling for comorbidities and disease severity.

Failure of initial therapy was the only prognostic factor that can be modified by an optimised management of disease.

The risk factors described in this study may help to better define CAP patients with increased mortality risk who require special attention during the course of disease.

This seems to be of particular importance because of the demographic changes in western countries with an increasing proportion of elderly patients and nursing home residents.

Title Of The Original Article
Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment

The European Respiratory Journal is the peer-reviewed scientific publication of the European Respiratory Society (more than 8,000 specialists in lung diseases and respiratory medicine in Europe, the United States and Australia).

European Respiratory Journal