1. BMC Infect Dis. 2018 Apr 24;18(1):192. doi: 10.1186/s12879-018-3098-5.
Effects of age, comorbidity and adherence to current antimicrobial guidelines on mortality in hospitalized elderly patients with community-acquired pneumonia.
Han X(1)(2), Zhou F(1), Li H(3)(4), Xing X(5), Chen L(6), Wang Y(3)(4), Zhang C(7), Liu X(2), Suo L(8), Wang J(9), Yu G(10), Wang G(11), Yao X(12), Yu H(13), Wang L(14), Liu M(15), Xue C(1), Liu B(8), Zhu X(16), Li Y(1), Xiao Y(1), Cui X(3)(4), Li L(3)(4), Purdy JE(17), Cao B(18)(19)(20); CAP-China network.
Author information: (1)Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Road, Chao-yang District, Beijing, China. (2)Department of Respiratory Medicine, Qingdao Municipal Hospital Group, Jiaozhou Road, Qingdao City, Shandong Province, China. (3)National Clinical Research Center of Respiratory Diseases, Center for Respiratory Diseases, China-Japan Friendship Hospital, Yinghuayuan East Street, Chao-yang District, Beijing, China. (4)Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Yinghuayuan East Street, Chao-yang District, Beijing, China. (5)Department of Respiratory Medicine, Yan'an Hospital Affiliated to Kunming Medical University, Renmin East Road, Kunming City, Yunnan Province, China. (6)Department of Infectious Disease, Beijing Jishuitan Hospital, Xinjiekou East Street, Xi-cheng District, Beijing, China. (7)Department of Respiratory Medicine, Beijing Huimin Hospital, Youanmen Street, Xi-cheng District, Beijing, China. (8)Department of Respiratory Medicine, Linzi District People's Hospital, Huangong Road, Zibo City, Shandong Province, China. (9)Department of Respiratory Medicine, Beijing Luhe Hospital, Capital Medical University, Xinhua South Road, Tongzhou District, Beijing, China. (10)Department of Pulmonary and Critical Care Medicine, Weifang No. 2 People's Hospital, Yuanxiao Street, Weifang City, Shandong Province, China. (11)Department of Respiratory Medicine, Shandong University Affiliated Qilu Hospital (Qingdao), Hefei Road, Qingdao City, Shandong Province, China. (12)Department of Respiratory Medicine, The 2nd Hospital of Beijing Corps, Chinese Armed Police Forces, Yuetan North Street, Xi-cheng District, Beijing, China. (13)Department of Infectious Disease, Qingdao University Medical College Affiliated Yantaiyuhuangding Hospital, Yudong Road, Yantai City, Shandong Province, China. (14)Department of Respiratory Medicine, Rizhao Chinese Medical Hospital Affiliated to Shandong Chinese Medical University, Wanghai Road, Rizhao City, Shandong Province, China. (15)Department of Respiratory Medicine, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Meishuguan Street, Dong-cheng District, Beijing, China. (16)Department of Occupational Medicine and Toxicology, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Road, Chao-yang District, Beijing, China. (17)Senior Director, Anti-infectives, Pfizer Inc, 500 Arcola Rd, F3203, Collegeville, PA, 19426, USA. (18)National Clinical Research Center of Respiratory Diseases, Center for Respiratory Diseases, China-Japan Friendship Hospital, Yinghuayuan East Street, Chao-yang District, Beijing, China. caobin_ben@163.com. (19)Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Yinghuayuan East Street, Chao-yang District, Beijing, China. caobin_ben@163.com. (20)Department of Pulmonary Medicine, Capital Medical University, Yinghuayuan East Street, Chao-yang District, Beijing, China. caobin_ben@163.com.
BACKGROUND: Limited 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.
METHODS: A 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.
RESULTS: The 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.
CONCLUSIONS: Overtreatment 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 REGISTRATION: The study was registered at ClinicalTrials.gov ( NCT02489578 ).
DOI: 10.1186/s12879-018-3098-5 PMCID: PMC5922029 PMID: 29699493
