Community-acquired pneumonia in the intensive care unit: epidemiological and prognosis data in older people

Details

Serval ID
serval:BIB_E895C75E5AED
Type
Article: article from journal or magazin.
Collection
Publications
Title
Community-acquired pneumonia in the intensive care unit: epidemiological and prognosis data in older people
Journal
J Am Geriatr Soc
Author(s)
Leroy O., Bosquet C., Vandenbussche C., Coffinier C., Georges H., Guery B., Alfandari S., Thevenin D., Beaucaire G.
ISSN
0002-8614 (Print)
ISSN-L
0002-8614
Publication state
Published
Issued date
05/1999
Volume
47
Number
5
Pages
539-46
Language
english
Notes
Leroy, O
Bosquet, C
Vandenbussche, C
Coffinier, C
Georges, H
Guery, B
Alfandari, S
Thevenin, D
Beaucaire, G
eng
Multicenter Study
J Am Geriatr Soc. 1999 May;47(5):539-46. doi: 10.1111/j.1532-5415.1999.tb02567.x.
Abstract
OBJECTIVES: To compare epidemiological data, etiology, and prognosis of severe community-acquired pneumonia (CAP) in the intensive care unit (ICU) according to age (< or > or = 65 years) and to determine prognostic factors of CAP in older people. DESIGN: A retrospective (1987-1992) and prospective (1993-95) multicenter study. SETTING: Six ICUs in the north of France. PATIENTS: Five hundred five patients admitted to an ICU for severe CAP. MEASUREMENTS: Patient characteristics were compared with regard to age. Prognosis of CAP in older patients was studied by stepwise discriminant analysis. RESULTS: Two hundred seventy-eight patients (55%) were aged 65 years or older. Comparison of epidemiological data between older and younger patients revealed a higher prevalence of women (38% vs 29%), more severe underlying comorbidities (anticipated death within 5 years: 59% vs 26%), and more frequent chronic respiratory insufficiency (48% vs 33%) in the older patients. In this study group, 224 organisms were isolated from 172 patients (62%); those identified most frequently were Gram-negative bacilli (34%), S. pneumoniae (32%), and Staphylococcus sp. (19%). Compared with younger patients, no significant differences in bacteriological data were observed. However, crude and attributable mortality rates were significantly higher in the older patients (33% vs 21% and 30% vs 19%, respectively). Prognosis analysis identified four independent predictors of mortality in the older patients: initial septic shock (relative risk (RR) = 3), sepsis-related complications (RR = 4.3), hospital-acquired lower respiratory tract superinfections (RR = 2), and nonspecific pneumonia-related complications (RR = 2.8). CONCLUSION: The bacterial etiology provides some approaches to empirical therapy for older patients with severe community-acquired pneumonia. In addition, the inappropriateness of withholding intensive care for reasons of age alone is emphasized.
Keywords
Age Factors, Aged, Community-Acquired Infections/mortality, Discriminant Analysis, Female, France, Humans, Intensive Care Units/*statistics & numerical data, Male, Middle Aged, Multivariate Analysis, Pneumonia, Bacterial/*mortality, Prognosis, Prospective Studies, Retrospective Studies, Survival Analysis
Pubmed
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29/04/2021 10:59
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30/04/2021 6:38
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