Abstract
BackgroundLimited information exists on the clinical characteristics predictive of mortality in patients aged ≥65 years in many countries. The impact of adherence to current antimicrobial guidelines on the mortality of hospitalized elderly patients with community-acquired pneumonia (CAP) has never been assessed.MethodsA total of 3131 patients aged ≥65 years were enrolled from a multi-center, retrospective, observational study initiated by the CAP-China network. Risk factors for death were screened with multivariable logistic regression analysis, with emphasis on the evaluation of age, comorbidities and antimicrobial treatment regimen with regard to the current Chinese CAP guidelines.ResultsThe mean age of the study population was 77.4 ± 7.4 years. Overall in-hospital and 60-day mortality were 5.7% and 7.6%, respectively; these rates were three-fold higher in those aged ≥85 years than in the 65–74 group (11.9% versus 3.2% for in-hospital mortality and 14.1% versus 4.7% for 60-day mortality, respectively). The mortality was significantly higher among patients with comorbidities compared with those who were otherwise healthy. According to the 2016 Chinese CAP guidelines, 62.1% of patients (1907/3073) received non-adherent treatment. For general-ward patients without risk factors for Pseudomonas aeruginosa (PA) infection (n = 2258), 52.3% (1094/2090) were over-treated, characterized by monotherapy with an anti-pseudomonal β-lactam or combination with fluoroquinolone + β-lactam; while 71.4% of intensive care unit (ICU) patients (120/168) were undertreated, without coverage of atypical bacteria. Among patients with risk factors for PA infection (n = 815), 22.9% (165/722) of those in the general ward and 74.2% of those in the ICU (69/93) were undertreated, using regimens without anti-pseudomonal activity. The independent predictors of 60-day mortality were age, long-term bedridden status, congestive heart failure, CURB-65, glucose, heart rate, arterial oxygen saturation (SaO2) and albumin levels.ConclusionsOvertreatment in general-ward patients and undertreatment in ICU patients were critical problems. Compliance with Chinese guidelines will require fundamental changes in standard-of-care treatment patterns. The data included herein may facilitate early identification of patients at increased risk of mortality.Trial registrationThe study was registered at ClinicalTrials.gov (NCT02489578).
Highlights
MethodsA total of 3131 patients aged ≥65 years were enrolled from a multi-center, retrospective, observational study initiated by the community-acquired pneumonia (CAP)-China network
Limited information exists on the clinical characteristics predictive of mortality in patients aged ≥65 years in many countries
The major findings of our study were as follows: 1) the overall in-hospital mortality and 60-day mortality rates were relatively low, 5.7% and 7. 6%, respectively, and age was the independent prognostic factor most associated with mortality; 2) 60% of patients had two or more comorbidities; congestive heart failure and long-term bedridden condition were independent risk factors of 60-day mortality; 3) 62.1% of patients received non-adherent treatment with antibiotics active for this genus
Summary
A total of 3131 patients aged ≥65 years were enrolled from a multi-center, retrospective, observational study initiated by the CAP-China network. Design and participants The current study was an observational study initiated by the CAP-China network. Validation of data quality was performed by a second group of specially assigned researchers before the case was entered into the CAP-China database. Those patients meeting all pre-defined inclusion/exclusion criteria were included in the analysis. Inclusion criteria included the following: (1) age ≥ 65 years; (2) one of the top five discharge diagnoses defined as CAP. CAP was defined as follows: (1) community onset; (2) presence of new infiltrate on chest X-ray or computed tomography scan together with at least one of the following: (i) new or increased cough (productive, nonproductive or with a change in sputum characteristics) with or without dyspnea, chest pain or hemoptysis, (ii) fever, (iii) rales and/or signs of consolidation, (iv) peripheral
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