Community-acquired pneumonia and nursing home-acquired pneumonia in the very elderly patients

Maruyama, Takaya; Gabazza, Esteban C.; Morser, John; Takagi, Takehiro; D'Alessandro-Gabazza, Corina; Hirohata, Shizu; Nakayama, Sei; Ramirez, Alexis Y.; Fujiwara, Atsushi; Naito, Masahiro; Nishikubo, Kimiaki; Yuda, Hisamichi; Yoshida, Masamichi; Takei, Yoshiyuki; Taguchi, Osamu

doi:10.1016/j.rmed.2009.12.008

« Previous Next »Respiratory Medicine
Volume 104, Issue 4 , Pages 584-592, April 2010

Community-acquired pneumonia and nursing home-acquired pneumonia in the very elderly patients

Takaya Maruyama
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan
Esteban C. Gabazza
- Department of Immunology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
- Corresponding author. Tel.: +81 59 231 5017; fax: +81 59 231 5225.
John Morser
- Division of Hematology, Stanford University School of Medicine, 269 Campus Drive, CCSR 1155, Stanford, CA 94305-5156, USA
Takehiro Takagi
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan
Corina D'Alessandro-Gabazza
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan
Shizu Hirohata
- Kinan General Hospital, 4750 Atawa, Mihama-chou, Minamimuro, Mie 519-5293, Japan
Sei Nakayama
- Kinan General Hospital, 4750 Atawa, Mihama-chou, Minamimuro, Mie 519-5293, Japan
Alexis Y. Ramirez
- Department of Immunology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture 514-8507, Japan
Atsushi Fujiwara
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan
Masahiro Naito
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan
Kimiaki Nishikubo
- Kinan General Hospital, 4750 Atawa, Mihama-chou, Minamimuro, Mie 519-5293, Japan
Hisamichi Yuda
- Mie Prefecture General Hospital, 5450-132 Hinaga, Yokkaichi, Mie 510-0885, Japan
Masamichi Yoshida
- Mie Prefecture General Hospital, 5450-132 Hinaga, Yokkaichi, Mie 510-0885, Japan
Yoshiyuki Takei
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan
Osamu Taguchi
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan

Received 14 December 2008; accepted 16 December 2009. published online 11 January 2010.

Summary

The rapid increase in the elderly population is leading to a corresponding increase in the number of people requiring medical care. To date no comparative study between community-acquired pneumonia (CAP) and nursing home-acquired pneumonia (NHAP) has been reported in the very elderly non-intubated patients. The present study was undertaken to compare the clinical characteristics and microbial etiology between CAP and NHAP in elderly patients ≥85-years old. There were 54 patients with NHAP and 47 with CAP. Performance status was significantly worse in the NHAP than in the CAP group. Among all patients, the most frequent pathogens were Chlamydophilia pneumoniae followed by Streptococcus pneumoniae, Mycoplasma pneumoniae influenza virus and Staphylococcus aureus. The frequency of S. peumoniae was significantly higher in NHAP patients than in CAP patients after adjusting for age and sex. Physical activity, nutrition status and dehydration were significant prognostic factors of pneumonia among all patients. In-hospital mortality was significantly higher in NHAP than in CAP after adjusting for age and sex. This study demonstrated that the etiology and clinical outcome differ between CAP and NHAP patients in the very elderly non-intubated population.

Keywords: Infection, Virus, Bacteria, Fungus, Elderly, Non-intubated patients