Distribution of Pathogens in Elderly Chinese Patients With Pneumonia: A Systematic Review and Meta-Analysis.

Luming Chen,Hongqiang Huang,Xiaolin Chen

doi:10.3389/fmed.2021.584066

Luming Chen, Hongqiang Huang + Show 1 more

Open Access

https://doi.org/10.3389/fmed.2021.584066

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Abstract

Background: To summarize the distribution of pathogenic bacteria in elderly Chinese patients with pneumonia and provide guidance for the clinical application of antibiotics.Methods: The electronic databases of PubMed, Embase, Cochrane library, and China National Knowledge Infrastructure were searched. The primary outcomes included the prevalence of gram-positive cocci, gram-negative bacilli, and fungus. The summary prevalence and 95% confidence interval (CI) were calculated using the random-effects model.Results: A total of 17 retrospective studies reporting a total of 5,729 elderly patients with pneumonia were selected for final analysis. The summary prevalence of gram-positive cocci was 25% (95% CI: 20–30%; p < 0.001), whereas the prevalence of gram-negative bacilli was 56% (95% CI: 46–67%; p < 0.001). Moreover, the pooled prevalence of fungus in elderly patients with pneumonia was 11% (95% CI: 8–14%; p < 0.001). The most common gram-positive cocci were Staphylococcus aureus (ES: 8%; 95% CI: 6–11%; p <0.001), Streptococcus hemolyticus (ES: 7%; 95% CI: 6–8%; p < 0.001), and Streptococcus pneumoniae (ES: 5%; 95% CI: 3–7%; p < 0.001). Pseudomonas aeruginosa (ES: 18%; 95% CI: 14–22%; p <0.001) and Klebsiella pneumoniae (ES: 14%; 95% CI: 11–18%; p <0.001) were most common gram-negative bacilli. Furthermore, the pooled prevalence of Candida albicans in elderly patients with pneumonia was 6% (95% CI: 5–8%; p < 0.001).Conclusions: The findings demonstrated the comprehensive distribution of pathogenic bacteria in elderly Chinese patients with pneumonia, which could guide further antibiotic therapies.

Highlights

Pneumonia is the leading cause of infection-related deaths worldwide and the fourth-highest allcause mortality in elderly patients
The most common gram-positive cocci were Staphylococcus aureus (ES: 8%; 95% confidence interval (CI): 6–11%; p < 0.001), Streptococcus hemolyticus (ES: 7%; 95% CI: 6–8%; p < 0.001), and Streptococcus pneumoniae (ES: 5%; 95% CI: 3–7%; p < 0.001)
Pseudomonas aeruginosa (ES: 18%; 95% CI: 14–22%; p < 0.001) and Klebsiella pneumoniae (ES: 14%; 95% CI: 11–18%; p < 0.001) were most common gram-negative bacilli

Summary

Introduction

Pneumonia is the leading cause of infection-related deaths worldwide and the fourth-highest allcause mortality in elderly patients (older than 65 years). It is characterized by cough, sputum production, dyspnea, and chest pain [1, 2]. The number of elderly patients with pneumonia is rapidly increasing due to increasing sociodemographic aging, which has become a global problem. The incidence of hospitalization due to pneumonia has significantly increased, and the burden of community-acquired pneumonia is more significant due to an expected 20% of the global population reaching elderly status by 2050 [4, 5]. To summarize the distribution of pathogenic bacteria in elderly Chinese patients with pneumonia and provide guidance for the clinical application of antibiotics

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Conclusion