Pneumonia in the elderly (geriatric) population
Pneumonia in the elderly (geriatric) population
复制标题
老年人群中的肺炎
DOI：
10.1097/01.mcp.0000158254.90483.1f
复制
发表时间：
2005
影响因子：
3.3
通讯作者：
J. Janssens
中科院分区：
文献类型：
--
作者：
J. Janssens
综述目的：回顾最近（2003年和2004年）关于高龄肺炎的研究。最近的研究结果社区获得性肺炎（CAP）的老年人住院与高死亡率和高再入院率在未来一年内。功能状态、精神状态改变、合并症数量、吸入性肺炎、肾功能衰竭和营养状况都是不良预后的指标。虽然肺炎链球菌、流感嗜血杆菌、肠杆菌和金黄色葡萄球菌是最常见的致病微生物，但病毒占CAP住院病例的26%。肺炎衣原体也与CAP和疗养院获得性肺炎（NHAP）有关，最近有报道称在疗养院爆发。吸入性肺炎在老年人中很常见，在鼻胃管或经皮胃肠管患者中发生频率增加。在严重的吸入性肺炎中，20%的微生物是厌氧的，80%是需氧的，其中大多数是革兰氏阴性肠杆菌科。不良的口腔卫生会增加随后患肺炎的风险：牙菌斑可能会成为CAP或NHAP中致病微生物的储存库。预防CAP和NHAP依赖于流感和肺炎球菌疫苗的联合使用，这降低了CAP的住院率和住院死亡率。总结最近的研究强调了吸入作为CAP常见机制的重要性，提供了关于这种情况下致病微生物的新见解，并强调了联合疫苗接种在降低发病率和死亡率方面的贡献。
Purpose of review Review of recent studies (2003 and 2004) concerning pneumonia in the very old. Recent findings Hospitalisation for community-acquired pneumonia (CAP) in the elderly is associated with a high mortality and with a high rate of readmission within the following year. Functional status, altered mental status, number of comorbidities, aspiration pneumonia, renal failure, and nutritional status are all indicators of adverse prognosis. Although Streptococcus pneumoniae, Haemophilus influenzae, Enterobacteriacae, and Staphylococcus aureus are the most frequently identified causative microorganisms, viruses account for up to 26% of hospital admissions for CAP. Chlamydia pneumoniae is also implicated in CAP and in nursing-home-acquired pneumonia (NHAP), with recent reports of outbreaks in nursing homes. Aspiration pneumonia is frequent in the elderly and occurs with increased frequency in patients with nasogastric tubes or percutaneous enterogastric tubes. In severe aspiration pneumonia, 20% of organisms implicated are anaerobic and 80% aerobic, most of which are gram-negative Enterobacteriaceae. Poor oral hygiene increases subsequent risk of pneumonia: dental plaque may act as a reservoir for pathogenic organisms implicated in CAP or NHAP. Prevention of CAP and NHAP relies on the combined use of influenza and pneumococcal vaccination, which decreases hospital admissions and in-hospital mortality for CAP. Summary Recent studies stress the importance of aspiration as a frequent mechanism of CAP, provide new insights as to causative organisms in this setting, and underline the contribution of combined vaccination in reducing morbidity and mortality.