Community-acquired pneumonia in elderly patients

Aging Health

Volumn 5, Issue 6, 2009, Pages 763-774

  Stupka, John E ^b   Mortensen, Eric M ^b   Anzueto, Antonio ^b   Restrepo, Marcos I ^a  

^a SOUTH TEXAS VETERANS HEALTH CARE SYSTEM   (United States)

^b UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO   (United States)

Author keywords

Aged; Microbiology; Pneumonia; Severity of illness index; Therapeutics

Indexed keywords

BETA LACTAM ANTIBIOTIC; CORTICOSTEROID; LEVOFLOXACIN; MACROLIDE; MOXIFLOXACIN; PNEUMOCOCCUS VACCINE; QUINOLINE DERIVED ANTIINFECTIVE AGENT;

ANTIBIOTIC THERAPY; CHLAMYDOPHILA PNEUMONIAE; CLINICAL TRIAL; CLOSTRIDIUM DIFFICILE INFECTION; COMMUNITY ACQUIRED PNEUMONIA; DISEASE SEVERITY; DRUG EFFICACY; DRUG SAFETY; GERIATRIC PATIENT; HOSPITALIZATION; HUMAN; INCIDENCE; INTENSIVE CARE UNIT; LEGIONELLA PNEUMOPHILA; METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS; MORTALITY; MYCOPLASMA PNEUMONIAE; PNEUMONIA SEVERITY INDEX; QT PROLONGATION; REVIEW; SMOKING CESSATION; SPUTUM ANALYSIS; VACCINATION;

EID: 74049107043     PISSN: 1745509X     EISSN: 17455103     Source Type: Journal    
DOI: 10.2217/ahe.09.74     Document Type: Review

References (72)

1. Janssens JP, Krause KH: Pneumonia in the very old. Lancet Infect. Dis. 4 (2), 112-124 (2004).
2. Kaplan V, Angus DC, Griffin MF, Clermont G, Scott Watson R, Linde-Zwirble WT: Hospitalized communityacquired pneumonia in the elderly: age-and sex-related patterns of care and outcome in the United States. Am. J. Respir. Crit. Care Med. 165 (6), 766-772 (2002).
3. Fine MJ, Smith MA, Carson CA et al.: Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis. JAMA 275 (2), 134-141 (1996).
4. Chong CP, Street PR: Pneumonia n the elderly: a review of the epidemiology, pathogenesis, microbiology, and clinical features. South Med. J. 101 (11), 1141-1145, quiz 32, 79 (2008). • Comprehensive literature review outlining the characteristics of pneumonia in elderly patients.
5. Velez JA, Mortensen EM, Anzueto A, Restrepo MI: Antimicrobial treatment of community-acquired pneumonia in the elderly. Aging Health 2 (6), 999-1011 (2006).
6. Ho JC, Chan KN, Hu WH et al.: The effect of aging on nasal mucociliary clearance, beat frequency, and ultrastructure of respiratory cilia. Am. J. Respir. Crit. Care Med. 163 (4), 983-988 (2001).
7. Valenti WM, Trudell RG, Bentley DW: Factors predisposing to oropharyngeal colonization with Gram-negative bacilli in the aged. N. Engl. J. Med. 298 (20), 1108-1111 (1978).
8. Kikuchi R, Watabe N, Konno T, Mishina N, Sekizawa K, Sasaki H: High incidence of silent aspiration in elderly patients with community-acquired pneumonia. Am. J. Respir. Crit. Care Med. 150 (1), 251-253 (1994).
9. Castle SC: Clinical relevance of age-related immune dysfunction. Clin. Infect. Dis. 31 (2), 578-585 (2000).
10. Meyer KC: The role of immunity in susceptibility to respiratory infection in the aging lung. Respir. Physiol. 128 (1), 23-31 (2001).
11. Kelly E, MacRedmond RE, Cullen G, Greene CM, McElvaney NG, O'Neill SJ: Community-acquired pneumonia in older patients: does age infuence systemic cytokine levels in community-acquired pneumonia? Respirology. 14 (2), 210-216 (2009). • Prospective observational study suggesting that elderly patients have similar cytokine responses to community-acquired pneumonia (CAP) when compared with younger cohorts.
12. Kothe H, Bauer T, Marre R, Suttorp N, Welte T, Dalhoff K: Outcome of communityacquired pneumonia: influence of age, residence status and antimicrobial treatment. Eur. Respir. J. 32 (1), 139-146 (2008). • Multicenter, prospective study focusing on clinical history, residence status, course of disease and antimicrobial treatment in elderly patients with CAP.
13. Ruiz M, Ewig S, Marcos MA et al.: Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity. Am. J. Respir. Crit. Care Med. 160 (2), 397-405 (1999).
14. Fernandez-Sabe N, Carratala J, Roson B et al.: Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes. Medicine (Baltimore). 82 (3), 159-169 (2003).
15. Hoyert DL, Kung HC, Smith BL: Deaths: preliminary data for 2003. Natl Vital Stat. Rep. 53 (15), 1-48 (2005).
16. Donowitz GR, Cox HL: Bacterial community-acquired pneumonia in older patients. Clin. Geriatr. Med. 23 (3), 515-534, VI (2007). • Review highlighting key aspects of CAP in elderly patients.
17. Jackson ML, Neuzil KM, Thompson WW et al.: The burden of community-acquired pneumonia in seniors: results of a populationbased study. Clin. Infect. Dis. 39 (11), 1642-1650 (2004).
18. Kaplan V, Clermont G, Griffin MF et al.: Pneumonia: still the old man's friend? Arch. Intern. Med. 163 (3), 317-323 (2003).
19. Hidron AI, Low CE, Honing EG, Blumberg HM: Emergence of communityacquired methicillin-resistant Staphylococcus aureus strain USA300 as a cause of necrotising community-onset pneumonia. Lancet Infect. Dis. 9 (6), 384-392 (2009).
20. Finegold SM: Legionnaires' disease - still with us. N. Engl. J. Med. 318 (9), 571-573 (1988).
21. Macfarlane JT, Miller AC, Roderick Smith WH, Morris AH, Rose DH: Comparative radiographic features of community acquired Legionnaires' disease, pneumococcal pneumonia, mycoplasma pneumonia, and psittacosis. Thorax 39 (1), 28-33 (1984).
22. Andrews J, Nadjm B, Gant V, Shetty N: Community-acquired pneumonia. Curr. Opin. Pulm. Med. 9 (3), 175-180 (2003).
23. Faix DJ, Sherman SS, Waterman SH: Rapid-test sensitivity for novel swine-origin influenza A (H1N1) virus in humans. N Engl. J. Med. 361 (7), 728-729 (2009).
24. Mandell LA, Wunderink RG, Anzueto A et al.: Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin. Infect. Dis. 44 (Suppl. 2), S27-S72 (2007).
25. Fine MJ, Auble TE, Yealy DM et al.: A prediction rule to identify low-risk patients with community-acquired pneumonia. N. Engl. J. Med. 336 (4), 243-250 (1997).
26. Lim WS, Lewis S, Macfarlane JT: Severity prediction rules in community acquired pneumonia: a validation study. Thorax 55 (3), 219-223 (2000).
27. Lim WS, van der Eerden MM, Laing R et al.: Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 58 (5), 377-382 (2003).
28. Metlay JP, Fine MJ: Testing strategies in the initial management of patients with community-acquired pneumonia. Ann. Intern. Med. 138 (2), 109-118 (2003).
29. Espana PP, Alberto C, Inmaculada G, Cristobal E, Mikel O, Miguel O: Development and validation of a clinical prediction rule for severe communityacquired pneumonia. Am. J. Respir. Crit. Care Med. 174 (11), 1249 (2006). • Multivariate analysis identifying eight independent factors that predict severe CAP.
30. Charles PG, Wolfe R, Whitby M et al.: SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin. Infect. Dis. 47 (3), 375-384 (2008). • Prospective study focusing on a tool for predicting the need for intensive respiratory or vasopressor support in patients with CAP.
31. Rello J, Rodriguez A, Lisboa T, Gallego M, Lujan M, Wunderink R: PIRO score for community-acquired pneumonia: a new prediction rule for assessment of severity in intensive care unit patients with communityacquired pneumonia. Crit. Care Med. 37 (2), 456-462 (2009). • Prospective, observational, cohort study designed to develop a severity assessment tool to predict mortality in CAP patients in the intensive care unit.
32. Anzueto A, Niederman MS, Pearle J et al.: Community-Acquired Pneumonia Recovery in the Elderly (CAPRIE) : efficacy and safety of moxifloxacin therapy versus that of levofoxacin therapy. Clin. Infect. Dis. 42 (1), 73-81 (2006).
33. Morganroth J, Dimarco JP, Anzueto A, Niederman MS, Choudhri S, Group CS: A randomized trial comparing the cardiac rhythm safety of moxifloxacin vs levofloxacin in elderly patients hospitalized with community-acquired pneumonia. Chest 128 (5), 3398-3406 (2005).
34. Rubinstein E, Camm J: Cardiotoxicity of fuoroquinolones. J. Antimicrob Chemo Ther. 49 (4), 593-596 (2002).
35. Feldman RB, Rhew DC, Wong JY, Charles RA, Goetz MB: Azithromycin monotherapy for patients hospitalized with community-acquired pneumonia: a 31/2-year experience from a veterans affairs hospital. Arch. Intern. Med. 163 (14), 1718-1726 (2003).
36. Erard V, Lamy O, Bochud PY, Bille J, Cometta A, Calandra T: Full-course oral levofloxacin for treatment of hospitalized patients with community-acquired pneumonia. Eur. J. Clin. Microbiol. Infect. Dis. 23 (2), 82-88 (2004).
37. Borrego F, Gleckman R: Principles of antibiotic prescribing in the elderly. Drugs Aging 11 (1), 7-18 (1997).
38. Bressler R, Bahl JJ: Principles of drug therapy for the elderly patient. Mayo Clin. Proc. 78 (12), 1564-1577 (2003).
39. Rodriguez A, Mendia A, Sirvent JM et al.: Combination antibiotic therapy improves survival in patients with community-acquired pneumonia and shock. Crit. Care Med. 35 (6), 1493-1498 (2007).
40. Baddour LM, Yu VL, Klugman KP et al.: Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am. J. Respir. Crit. Care Med. 170 (4), 440-444 (2004).
41. Martinez JA, Horcajada JP, Almela M et al.: Addition of a macrolide to a β-lactambased empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia. Clin. Infect. Dis. 36 (4), 389-395 (2003).
42. Lujan M, Gallego M, Fontanals D, Mariscal D, Rello J: Prospective observational study of bacteremic pneumococcal pneumonia: effect of discordant therapy on mortality. Crit. Care Med. 32 (3), 625-631 (2004).
43. Waterer GW, Baselski VS, Wunderink RG: Legionella and community-acquired pneumonia: a review of current diagnostic tests from a clinician's viewpoint. Am. J. Med. 110 (1), 41-48 (2001).
44. Mufson MA: Pneumococcal pneumonia. Curr. Infect. Dis. Rep. 1 (1), 57-64 (1999).
45. Restrepo MI, Mortensen EM, Waterer GW, Wunderink RG, Coalson JJ, Anzueto A: Impact of macrolide therapy on mortality for patients with severe sepsis due to pneumonia. Eur. Respir. J. 33 (1), 153-159 (2009). • Retrospective cohort study that suggested that macrolide therapy was associated with lower mortality even in CAP patients even when CAP was caused by macrolideresistant pneumonia pathogens.
46. Giamarellos-Bourboulis EJ, Baziaka F, Antonopoulou A et al.: Clarithromycin co-administered with amikacin attenuates systemic inflammation in experimental sepsis with Escherichia coli. Int. J. Antimicrob. Agents 25 (2), 168-172 (2005).
47. Giamarellos-Bourboulis EJ: Immunomodulatory therapies for sepsis: unexpected effects with macrolides. Int. J. Antimicrob. Agents 32 (Suppl. 1), S39-S43 (2008).
48. Metersky ML, Ma A, Houck PM, Bratzler DW: Antibiotics for bacteremic pneumonia: improved outcomes with macrolides but not fluoroquinolones. Chest 131 (2), 466-473 (2007).
49. Woodhead M, Blasi F, Ewig S et al.: Guidelines for the management of adult lower respiratory tract infections. Eur. Respir. J. 26 (6), 1138-1180 (2005).
50. Mandell LA, Bartlett JG, Dowell SF, File TM Jr, Musher DM, Whitney C; Infectious Diseases Society of America: Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin. Infect. Dis. 7 (11), 1405-1433 (2003).
51. Niederman MS, Mandell LA, Anzueto A et al.: Guidelines for the management of adults with community-acquired pneumonia. diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am. J. Respir. Crit. Care Med. 163 (7), 1730-1754 (2001).
52. Bodi M, Rodriguez A, Sole-Violan J et al.: Antibiotic prescription for communityacquired pneumonia in the intensive care unit: impact of adherence to infectious diseases society of america guidelines on survival. Clin. Infect. Dis. 41 (12), 1709-1716 (2005).
53. Dean NC, Silver MP, Bateman KA, James B, Hadlock CJ, Hale D: Decreased mortality after implementation of a treatment guideline for community-acquired pneumonia. Am. J. Med. 110 (6), 451-457 (2001).
54. Garcia Vazquez E, Mensa J, Martinez JA et al.: Lower mortality among patients with community-acquired pneumonia treated with a macrolide plus a β-lactam agent versus a β-lactam agent alone. Eur. J. Clin. Microbiol. Infect. Dis. 24 (3), 190-195 (2005).
55. Mortensen EM, Restrepo M, Anzueto A, Pugh J: Effects of guideline-concordant antimicrobial therapy on mortality among patients with community-acquired pneumonia. Am. J. Med. 117 (10), 726-731 (2004).
56. Restrepo MI, Mortensen EM, Anzueto A, Pugh JA: Mortality in monotherapy versus combination therapy in severe community-acquired pneumonia: a systematic review. Chest 124 (Suppl. 4), S190 (2003).
57. Menendez R, Torres A, Zalacain R et al.: Guidelines for the treatment of community-acquired pneumonia: predictors of adherence and outcome. Am. J. Respir. Crit. Care Med. 172 (6), 757-762 (2005).
58. Confalonieri M, Urbino R, Potena A et al.: Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. Am. J. Respir. Crit. Care Med. 171 (3), 242-248 (2005).
59. Garcia-Vidal C, Calbo E, Pascual V, Ferrer C, Quintana S, Garau J: Effects of systemic steroids in patients with severe communityacquired pneumonia. Eur. Respir. J. 30 (5), 951-956 (2007).
60. Laterre PF, Garber G, Levy H et al.: Severe community-acquired pneumonia as a cause of severe sepsis: data from the PROWESS study. Crit. Care Med. 33 (5), 952-961 (2005).
61. The Acute Respiratory Distress Syndrome Network: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N. Engl. J. Med. 342 (18), 1301-1308 (2000).
62. Tleyjeh IM, Kashour T, Hakim FA et al.: Statins for the prevention and treatment of infections: a systematic review and meta-analysis. Arch. Intern. Med. 169 (18), 658-1667 (2009).
63. Thomsen RW, Riis A, Kornum JB et al.: Preadmission use of statins and outcomes after hospitalization with pneumonia: population-based cohort study of 29, 900 patients. Arch. Intern. Med 168 (19), 2081-2087 (2008).
64. Chalmers JD, Singanayagam A, Murray MP, Hill AT: Prior statin use is associated with improved outcomes in community-acquired pneumonia. Am. J. Med. 121 (11), 1002-1007 E1 (2008).
65. Mortensen EM, Pugh MJ, Copeland LA et al.: Impact of statins and angiotensinconverting enzyme inhibitors on mortality of subjects hospitalised with pneumonia. Eur. Respir. J. 31 (3), 611-617 (2008).
66. Pavia M, Foresta MR, Carbone V, Angelillo IF: Influenza and pneumococcal immunization in the elderly: knowledge, attitudes, and practices among general practitioners in Italy. Public Health. 117 (3), 202-207 (2003).
67. Huang YP, Gauthey L, Michel M et al.: The relationship between influenza vaccine-induced specific antibody responses and vaccine-induced nonspecific autoantibody responses in healthy older women. J. Gerontol. 47 (2), M50-M55 (1992).
68. Eurich DT, Marrie TJ, Johnstone J, Majumdar SR: Mortality reduction with influenza vaccine in patients with pneumonia outside 'fu' season: pleiotropic benefits or residual confounding? Am. J. Respir. Crit. Care Med. 178 (5), 527-533 (2008).
69. Rubins JB, Alter M, Loch J, Janoff EN: Determination of antibody responses of elderly adults to all 23 capsular polysaccharides after pneumococcal vaccination. Infect. Immun. 67 (11), 5979-5984 (1999).
70. Spaude KA, Abrutyn E, Kirchner C, Kim A, Daley J, Fisman DN: Influenza vaccination and risk of mortality among adults hospitalized with community-acquired pneumonia. Arch. Intern. Med. 167 (1), 53-59 (2007).
71. Bassim CW, Gibson G, Ward T, Paphides BM, Denucci DJ: Modification of the risk of mortality from pneumonia with oral hygiene care. J. Am. Geriatr. Soc. 56 (9), 1601-1607 (2008).
72. Panchabhai TS, Dangayach NS, Krishnan A, Kothari VM, Karnad DR: Oropharyngeal cleansing with 0.2% chlorhexidine for prevention of nosocomial pneumonia in critically ill patients: an open-label randomized trial with 0.01% potassium permanganate as control. Chest 135 (5), 1150-1156 (2009).