SESSION TITLE: Chest infections Posters II
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM
PURPOSE: Several studies have demonstrated a higher mortality of community-acquired pneumonia (CAP) in older comparing to younger adults but not in patients with diabetes mellitus (DM). The aim of the study was to compare the clinical characteristics and the mortality of CAP in older diabetic adults with that of younger diabetic adults and determine predictors of mortality in older adults with DM.
METHODS: A retrospective cohort study was conducted among hospitalized patients with CAP and DM. Fisher’s exact test and Wilcoxon rank-sum test were used for categorical and coninuous variables, respectively. Multivariate logistic regression analysis was used to determine predictors of mortality in older diabetic adults with CAP.
RESULTS: A total of 215 patients were identified to have CAP and DM and 157 of them were ≥ 65 years of age. Thirty (19.1%) of older adults and 3 (5.2%) of younger adults died (p=0.01). Older adults had more comorbid conditions(p= 0.0002), more severe CAP with pneumonia severity index(PSI) IV and V(p=<0.0001), and more delay in administration of first dose of appropriate antibiotic therapy for CAP (p=0.01)than younger adults. Seventeen (56.67%) out of the 30 older adults who died received their first dose of appropriate antibiotic for CAP > 8 hours of triage while 26 (20.47%) of the survived older adults received their first dose > 8 hours of triage at ED (p= <0.0001).Thirteen of 114 (11.4%) older adults who received their first appropriate antibiotics in ≤ 8 hours after triage died, while 17 of 43 (39.5%) older adults who received their first appropriate antibiotics > 8 hours after triage died (p= < 0.0001). In the multivariate analysis, increased in-hospital mortality of CAP in older diabetic adults were associated with: administration of appropriate antibiotic therapy longer than 8 hours after triage (OR 5.9,95% CI 2.0 - 17.4, p= 0.001), severe CAP with PSI class V (OR 3.4, 95% CI 1.2 - 9.9, p= 0.03), presence of complications (OR 5.4, 95% CI 1.9 - 15.6, p=0.002), and duration of symptoms before presentation >3 days (OR 3.20, 95% CI 1.1 - 9.7, p=0.04)
CONCLUSIONS: CAP is associated with a higher mortality in older diabetic adults than younger adults due to comorbid conditions, severity of pneumonia and delayed antibiotic therapy.
CLINICAL IMPLICATIONS: Clinicians , particulary at emergency department, shoud diagnose CAP as early as possible and start first dose of appropriate antibiotic therapy at the emergency room which may improve the high mortality of CAP among older diabetic adults
DISCLOSURE: The following authors have nothing to disclose: mazen bader, yanqing yi, kassem Abouchehade, Lisa Bishop, john Hawboldt
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