Original Research: Chest Infections |

Impact of Age and Comorbidity on Cause and Outcome in Community-Acquired PneumoniaAge, Etiology, and Community-Acquired Pneumonia

Catia Cillóniz, PhD; Eva Polverino, PhD; Santiago Ewig, PhD; Stefano Aliberti, MD; Albert Gabarrús, MSc; Rosario Menéndez, PhD; Josep Mensa, MD; Francesco Blasi, MD; Antoni Torres, PhD, FCCP
Author and Funding Information

From the Department of Respiratory Diseases (Drs Cillóniz, Polverino, and Torres and Mr Gabarrús), Institut del Tórax, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028) (Drs Cillóniz, Polverino, Menéndez, and Torres and Mr Gabarrús) Barcelona, Spain; the Department of Infectious Disease (Dr Mensa), Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain; the Department of Respiratory Diseases (Dr Menéndez), Hospital La Fe de Valencia, CibeRes, Valencia, Spain; Thoraxzentrum Ruhrgebiet (Dr Ewig), Kliniken für Pneumologie und Infektiologie, EVK Herne und Augusta-Kranken-Anstalt, Bochum, Germany; Dipartimento di Medicina Clinica e Prevenzione (Dr Aliberti), University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy; and Respiratory Medicine Section (Dr Blasi), Dipartimento Toraco-Polmonare e Cardiocircolatorio, University of Milan, IRCCS Fondazione Ca` Granda Ospedale Maggiore, Milan, Italy.

Correspondence to: Antoni Torres, PhD, FCCP, Department of Pneumology, Hospital Clinic of Barcelona, Calle Villarroel 170, Barcelona, Spain; e-mail: atorres@clinic.ub.es

Funding/Support: This study was funded by Ciber de Enfermedades Respiratorias [CibeRes CB06/06/0028] 2009 Support to Research Groups of Catalonia 911.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2013;144(3):999-1007. doi:10.1378/chest.13-0062
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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.

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