PNEUMONIA IN NURSING HOME RESIDENTS
Abstract
Background. Pneumonia remains one of the leading causes of morbidity and mortality worldwide, especially in advanced age. Prognosis of the disease depends on premorbid condition and immune competence of the patient, severity of the disease and causative microorganism. In our analysis we wanted to establish clinical, x-ray and microbiological characteristics of pneumonia in nursing home residents, estimate suitability of therapeutic measures and find out risk factors for adverse outcome in this group of patients.
Material and methods. This retrospective study includes all nursing home residents hospitalised due to CAP in Hospital Golnik in 2000. Clinical data was/were evaluated according to case history. Microbiological data and laboratory results were gathered from the patients files. Chi-square test was used for statistical analysis.
Results. 30 patients, 17 women were included, aged 82.5 ± 11.7 years. 60% of patients had at least 2 accompanying diseases, most frequently cardiovascular and neurologic diseases. At admittance 83% of patients presented with severe form of the disease. Dispnea (93%), tachypnea, cough (67%) and confusion (47%) dominate clinical picture. Patients rarely expectorate, are frequently hypoxemic (93%), have leucocytosis (63%), electrolyte disturbances and elevated urea (67%). According to the microbiologic results most frequent causative agents are Enterobacteriae, S. pneumoniae, H. influenzae and also some multiresistant bacteria. Amoxycillin with clavulanic acid was the most frequently used antibiotic, followed by macrolides and 3rd generation cephalosporines.
9 patients died, mortality rate was 30%. Their average age was 83,4 years, 67% of them had more than 2 accompanying diseases, all of them severe form of the disease, 89% severe respiratory insufficiency and 22% positive hemoculture.
Conclusions. Patients are characterised with numerous comorbidities and advanced age. Clinical presentation is unspecific. Mortality is high. Effective therapy is composed from adequate support measures and proper choice of antibiotic – amoxycillin with clavulanic acid, cephalosporines of high generation or antipneumococcal quinolone.
Downloads
References
Feldman C. Pneumonia in the elderly. Clin Chest Med 1999; 20: 563–73.
Wort SJ. Community acquired pneumonia in elderly people. BMJ 1998; 316: 1690–0.
American Thoracic Society. Guidelines for the management of adults with community acquired pneumonia. Am J Respir Crit Care Med 2001; 163: 1730–54.
Mušič E, Vencelj B, Bajrovič N, Eržen R, Šorli J. Hospitaly treated community acquired pneumonia in the elderly. Atemwegs- und Lungenkrankenheiten 1999; 25: 468–71.
Mušič E, Zupančič M, Debeljak A, Šorli J. Priporočila za diagnostiko in zdravljenje pljučnice domačega okolja. Zdrav Vestn 1997; 66: 255–60.
Bates JH, Campbell GD, Barron AL, McCracken GA et al. Microbial etiology of acute pneumonia in hospitalised patients. Chest 1992; 101: 1005–12.
Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weisfeld LA et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997; 336: 243–50.
Troy CJ, Peeling RW, Ellis AG, Hockin JC, Bennett DA, Murphy MR, Spika JS. Chlamydia pneumoniae as a new source of infectious outbreaks in nursing homes. JAMA 1997; 277: 1214–8.
Bartlett JG, Dowell SF, Mandell LA, File TM, Musher DM, Fine MJ. Practice guidelines for the management of community-acquired pneumonia in adults. Clin Infect Dis 2000; 31: 347–82.
Gleason PP, Meehan TP, Fine JM, Galusha DH, Fine MJ. Associations between initial antimicrobial therapy and medical outcomes for hospitalised elderly patients with pneumonia. Arch Intern Med 1999; 159: 2562–72.
Skerett SJ. Diagnostic testing for community-acquired pneumonia. Clin Chest Med 1999; 20: 531–48.
Hasley PB et al. Do pulmonary radiographic findings at presentation predict mortality in patients with community-acquired pneumonia? Arch Intern Med 1996; 156: 2206–12.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.