Etiology of severe pneumonia in the very elderly
Etiology of severe pneumonia in the very elderly
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DOI：
10.1164/ajrccm.163.3.2005075
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发表时间：
2001-03-01
影响因子：
24.7
通讯作者：
Davies, J
中科院分区：
文献类型：
--
作者：
El-Solh, AA;Sikka, P;Davies, J
由于缺乏全面的研究和诊断方法的产量低，高龄老人需要机械通气的重症肺炎的病因尚不准确。总体而言，对两家大学附属医院的 104 名 75 岁及以上患有严重肺炎的患者进行了前瞻性研究。微生物检查包括血培养、血清学、胸水和支气管肺泡分泌物。肺炎链球菌 (14%)、革兰氏阴性肠杆菌 (14%)、军团菌。 (9%)、流感嗜血杆菌(7%)和金黄色葡萄球菌(7%)是社区获得性肺炎(CAP)的主要病原体。金黄色葡萄球菌（29%）、革兰氏阴性肠杆菌（15%）、肺炎链球菌（9%）和铜绿假单胞菌（4%）占疗养院获得性肺炎（NHAP）分离株的大部分。病死率为 55%（CAP 为 53%，NHAP 为 57%；p > 0.5）。日常生活活动（ADL）指数、肺部、内分泌和中枢神经系统（CNS）合并症与不同的微生物病因相关。通过多变量分析，医院死亡率与 24 小时尿量（比值比 [OR]，5.6；95% 置信区间 [CI]，2.5 至 7.9；p < 0.001）、感染性休克（OR 4.3；95% CI，1.9 至 8.9；p = 0.0059）、影像学多肺叶受累（OR，3.7；p = 0.0059）独立相关。 95% CI，1.8 至 15.6； 0.02），以及抗菌治疗不足（08，2.6；95% CI，1.4 至 23.9；p = 0.034）。进一步的研究应侧重于在随机试验中确定有效的抗菌疗法。
The etiology of severe pneumonia requiring mechanical ventilation in the very elderly has been imprecise because of lack of comprehensive studies and low yield of diagnostic approach. Overall, 104 patients 75 yr of age and older with severe pneumonia were studied prospectively at two university-affiliate hospitals. Microbial investigation included blood culture, serology, pleural fluid, and bronchoalveolar secretions. Streptococcus pneumoniae (14%), gram-negative enteric bacilli (14%), Legionella sp. (9%), Hemophilus influenzae (7%), and Staphylococcus aureus (7%) were the predominant pathogens in community-acquired pneumonia (CAP). Staphylococcus aureus (29%), gram-negative enteric bacilli (15%), Streptococcus pneumoniae (9%), and Pseudomonas aeruginosa (4%) accounted for most isolates of nursing home-acquired pneumonia (NHAP). The case fatality rate was 55% (53% for CAP and 57% for NHAP; p > 0.5). Activity of Daily Living (ADL) Index, pulmonary, endocrine and central nervous system (CNS) comorbidities were associated with distinct microbial etiology. By multivariate analysis, hospital mortality was associated independently with 24-h urine output (odds ratio [OR], 5.6; 95% confidence interval [CI], 2.5 to 7.9; p < 0.001), septic shock (OR 4.3; 95% CI, 1.9 to 8.9; p = 0.0059), radiographic multilobar involvement (OR, 3.7; 95% CI, 1.8 to 15.6; p = 0.02), and inadequate antimicrobial therapy (08, 2.6; 95% CI, 1.4 to 23.9; p = 0.034). Further studies should focus on identifying effective antimicrobial regimens in randomized trials.