Neumonía adquirida en la comunidad en el anciano inmunocompetente que requiere hospitalización. Cuadro clínico, factores pronósticos y tratamiento

Abstract

Community-acquired pneumonia (CAP) is the leading cause of death from infectious disease among the elderly. This study was carried out to examine the clinical manifestations, etiology, prognostic factors and treatment of CAP in immunocompetent elderly patients requiring hospitalization. A total of 306 elderly (80 +/- 7 years) patients were evaluated: 54% were male, 89% had concurrent diseases (principally cardiovascular and neurological disease, chronic obstructive lung disease and diabetes), and 97% were treated with second-or third-generation cephalosporins. Mean hospital stay was 10 days, and mortality was approximately 10% in hospital and around 13% on follow up at 30 days. As compared to younger CAP patients, multiple comorbidity, altered mental status, hypoxemia, high serum urea nitrogen on hospital admission were more frequent in the elderly. Intermediate care and intensive care unit admissions were also more frequent in the elderly. Hospital length of stay as well as mortality in the hospital and at 30 days were higher in elderly patients. The pathogen was identified as part of routine care in around 25% of cases. The most frequent pathogens were Streptococcus pneumoniae (10.5%), enteric Gram negative bacilli (5.2%), Staphylococcus aureus (4.2%) and Haemophilus influenzae (3.9%). In multivariate analysis the prognostic factors on admission associated with in-hospital mortality were advanced age (> 83 years), absence of cough, low blood pressure and hyperphosphatemia. CAP in elderly patients is a prevalent disease with specific clinical and epidemiological characteristics, clinical course and prognosis.