Community-acquired pneumonia in the elderly:: Spanish multicentre study

Community-acquired pneumonia (CAP) in the elderly has increased as a consequence of an overall increase of the elderly population. A controversy about the aetiology and outcome of CAP in this population still exists and more epidemiological studies are needed. A prospective, 12-month, multicentre study was carried out to assess the clinical characteristics, aetiology, evolution and prognostic factors of elderly patients (greater than or equal to65 yrs) admitted to hospital for CAP. The study included 503 patients (age 76+/- 7 yrs). The clinical picture lasted less than or equal to5 days in 318 (63%) and the main clinical features were cough (n=407, 81%) and fever (n =380, 76%). Aetiological diagnosis was achieved in 199 (40%) cases, with a definite diagnosis obtained in 164 (33%). Of the 223 microorganisms isolated the main agents found were Streptococcus pneumoniae in 98 (49%) and Haeniophilus influenzae in 27 (14%). A total of 53 patients died (11%) and the multivariate analysis showed the following factors of bad prognosis: previous bed confinement, alteration in mental status, absence of chills, plasma creatinine greater than or equal to1.4 mg.dL(-1), oxygen tension in arterial blood/inspiratory oxygen fraction ratio <200 at the time of admission, and shock and renal failure during the evolution. The results of this study may aid in the management of empiric antibiotic treatment in elderly patients with community-acquired pneumonia and the patients who have a greater probability of bad evolution may be identified based on the risk factors.