Clinical characteristics and etiological analysis of community-acquired pneumonia in the elderly aged 80 and over_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

YU Xiaoli ¹ , YU Ting ² ,  CHEN Yusheng ¹ , LI Hongru ¹ , YUE Wenxiang ¹ , LIN Ming ¹ , HU Xinlan ³

1. Provincial Clinical Medical College Affiliated to Fujian Medical University; Department of Respiratory and Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, Fujian 350001, P. R. China;
2. Department of General Practice, Fujian Provincial Hospital, Fuzhou, Fujian 350001, P. R. China;
3. Microbiology Department, Fujian Provincial Hospital, Fuzhou, Fujian 350001, P. R. China;

Corresponding author：

CHEN Yusheng, Email: 672583894@qq.com

Keywords：

The very elderly; community-acquired pneumonia; clinical characteristics; etiology

DOI：

10.7507/1671-6205.202005081

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Objective To analyze the clinical features and etiologic of community-acquired pneumonia (CAP) among the elderly aged 80 and over, and provide evidence for clinical diagnosis and treatment. Methods The clinical characteristics and etiology of the elderly CAP (≥80 years old) were analyzed by collecting and comparing the clinical characteristics and etiology between the very elderly CAP group (≥80 years old, 94 cases) and control group (65 to 79 years old, 100 cases). Results On clinical symptoms, there were statistical differences in dyspnea and gastrointestinal symptoms, systemic symptoms, and mental status (P<0.05) between the two groups. There was no statistically significant difference in upper respiratory tract symptoms, fever, cough, sputum, hemoptysis and chest pain between the two groups (P>0.05). On the complications, the very elderly CAP group was more prone to respiratory failure, sepsis, urinary tract infection and electrolyte metabolism than the control group (P<0.05). On the experimental indicators, anemia and abnormal renal function in the elderly CAP group were high (P<0.05). There was no statistical difference between the two groups of inflammation indicators (white blood count, procalcitonin, C-reactive protein, erythrocyte sedimentation rate, neutrophil alkaline phosphatase score). The pneumonia severity index score and CURB-65 score of the very elderly CAP group were significantly higher than those of the control group (P<0.001). On pathogen analysis, in the very elderly CAP group the number of bacterial infections (23/94), viral infections (21/94) and bacterial mixed virus infections (21/94) were probably equivalent, and the proportion of bacterial infections of two or more types accounted for 17.0% (16/94); The bacteria detection rate was Streptococcus pneumoniae (22.4%), Pseudomonas aeruginosa (19.4%), Stenotrophomonas maltophilia (16.4%), Staphylococcus aureus (14.9%). Viral infection mainly focused on influenza A virus (23/94) and human cytomegalovirus (21/94). Bacterial mixed virus infection was mainly caused by Streptococcus pneumoniae and influenza A virus infection. Comparing the two groups, the most common bacterial pathogen both of them was Streptococcus pneumoniae, but the overall proportion was dominated by gram-negative bacteria, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Acinetobacter baumannii and Klebsiella pneumoniae were more common; the gram-positive bacteria in the two groups were mainly Streptococcus pneumoniae and Staphylococcus aureus. There was no significant difference in the detection rate of above Gram-positive bacteria between the two groups (P>0.05). The two groups of virus infections were mainly influenza A virus, and the difference was not statistically significant (P>0.05). The two groups of single bacteria rate, single virus infection rate, double virus infection rate and bacterial mixed virus infection rate were similar, the difference had not been found (P>0.05). Conclusions The elderly (aged 80 and over) CAP group is prone to dyspnea, often presents with extrapulmonary atypical symptoms such as digestive tract symptoms, systemic symptoms and psychiatric symptoms, and usually accompanied with many complications. The etiological treatment mainly covers gram-negative bacteria, and we must pay attention to the possibility of combined virus infection.

Citation： YU Xiaoli, YU Ting, CHEN Yusheng, LI Hongru, YUE Wenxiang, LIN Ming, HU Xinlan. Clinical characteristics and etiological analysis of community-acquired pneumonia in the elderly aged 80 and over. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(2): 90-95. doi: 10.7507/1671-6205.202005081 Copy

1.	Gutiérrez F, Masiá M, Mirete C, et al. The influence of age and gender on the population-based incidence of community-acquired pneumonia caused by different microbial pathogens. J Infect, 2006, 53(3): 166-174.
2.	Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among U. S. adults. N Engl J Med, 2015, 373(5): 415-427.
3.	Takayanagi N, Hara K, Tokunaga D, et al. Etiology and outcome of community-acquired pneumonia in relation to age and severity in hospitalized adult patients. Nihon Kokyuki Gakkai Zasshi, 2006, 44(12): 906-915.
4.	中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南. 中华结核和呼吸杂志, 2016, 39(4): 253-279.
5.	Metlay JP, Fine MJ. Testing strategies in the initial management of patients with community-acquired pneumonia. Ann Intern Med, 2003, 138: 109-118.
6.	李音, 姜红妮, 瞿介明. 老年、高龄老年和超高龄老年社区获得性肺炎的临床特征及预后对照分析. 老年医学与保健, 2016, 22(1): 19-23.
7.	Zalacain R, Torres A, Celis R, et al. Community acquired pneumonia in the elderly: Spanish multicentre study. Eur Respir J, 2003, 21(2): 294-302.
8.	Riquelme R, Torres A, El-Ebiary M, et al. Community-acquired pneumonia in the elderly. Clinical and nutritional aspects. Am J Respir Crit Care Med, 1997, 156: 1908-1914.
9.	槐永军, 张桂驰, 杨力敏, 等. 老年人社区获得性肺炎的临床特征及诊治分析. 临床军医杂志, 2015, 43(3): 267-269.
10.	de Roux A, Marcos MA, Garcia E, et al. Viral community-acquired pneumonia in nonimmunocompromised adults. Chest, 2004, 125(4): 1343-1351.
11.	Liu Y, Chen M, Zhao T, et al. Causative agent distribution and antibiotic therapy assessment among adult patients with community acquired pneumonia in Chinese urban population. BMC Infect Dis, 2009, 9: 31.
12.	Tao LL, Hu BJ, He LX, et al. Etiology and antimicrobial resistance of community-acquired pneumonia in adult patients in China. Chin Med J, 2012, 125(17): 2967-2972.
13.	Ruiz M, Ewig S, Marcos MA, et al. Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity. Am J Respir Crit Care Med, 1999, 160(2): 397-405.
14.	Templeton KE, Scheltinga SA, van den Eeden WC, et al. Improved diagnosis of the etiology of community-acquired pneumonia with real-time polymerase chain reaction. Clin Infect Dis, 2005, 41: 345-351.
15.	Holter JC, Müller F, Bjørang O, et al. Etiology of community-acquired pneumonia and diagnostic yields of microbiological methods: a 3-year prospective study in Norway. BMC Infect Dis, 2015, 15: 64.
16.	Cillóniz C, Ewig S, Ferrer M, et al. Community-acquired polymicrobial pneumonia in the intensive care unit: aetiology and prognosis. Crit Care, 2011, 15(5): R209.
17.	Finelli L, Fiore A, Dhara R, et al. Influenza-associated pediatric mortality in the United States: increase of Staphylococcus aureus coinfection. Pediatrics, 2008, 122(4): 805-811.
18.	McCullers JA. Insights into the interaction between influenza virus and pneumococcus. Clin Microbiol Rev, 2006, 19(3): 571-582.

1. Gutiérrez F, Masiá M, Mirete C, et al. The influence of age and gender on the population-based incidence of community-acquired pneumonia caused by different microbial pathogens. J Infect, 2006, 53(3): 166-174.
2. Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among U. S. adults. N Engl J Med, 2015, 373(5): 415-427.
3. Takayanagi N, Hara K, Tokunaga D, et al. Etiology and outcome of community-acquired pneumonia in relation to age and severity in hospitalized adult patients. Nihon Kokyuki Gakkai Zasshi, 2006, 44(12): 906-915.
4. 中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南. 中华结核和呼吸杂志, 2016, 39(4): 253-279.
5. Metlay JP, Fine MJ. Testing strategies in the initial management of patients with community-acquired pneumonia. Ann Intern Med, 2003, 138: 109-118.
6. 李音, 姜红妮, 瞿介明. 老年、高龄老年和超高龄老年社区获得性肺炎的临床特征及预后对照分析. 老年医学与保健, 2016, 22(1): 19-23.
7. Zalacain R, Torres A, Celis R, et al. Community acquired pneumonia in the elderly: Spanish multicentre study. Eur Respir J, 2003, 21(2): 294-302.
8. Riquelme R, Torres A, El-Ebiary M, et al. Community-acquired pneumonia in the elderly. Clinical and nutritional aspects. Am J Respir Crit Care Med, 1997, 156: 1908-1914.
9. 槐永军, 张桂驰, 杨力敏, 等. 老年人社区获得性肺炎的临床特征及诊治分析. 临床军医杂志, 2015, 43(3): 267-269.
10. de Roux A, Marcos MA, Garcia E, et al. Viral community-acquired pneumonia in nonimmunocompromised adults. Chest, 2004, 125(4): 1343-1351.
11. Liu Y, Chen M, Zhao T, et al. Causative agent distribution and antibiotic therapy assessment among adult patients with community acquired pneumonia in Chinese urban population. BMC Infect Dis, 2009, 9: 31.
12. Tao LL, Hu BJ, He LX, et al. Etiology and antimicrobial resistance of community-acquired pneumonia in adult patients in China. Chin Med J, 2012, 125(17): 2967-2972.
13. Ruiz M, Ewig S, Marcos MA, et al. Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity. Am J Respir Crit Care Med, 1999, 160(2): 397-405.
14. Templeton KE, Scheltinga SA, van den Eeden WC, et al. Improved diagnosis of the etiology of community-acquired pneumonia with real-time polymerase chain reaction. Clin Infect Dis, 2005, 41: 345-351.
15. Holter JC, Müller F, Bjørang O, et al. Etiology of community-acquired pneumonia and diagnostic yields of microbiological methods: a 3-year prospective study in Norway. BMC Infect Dis, 2015, 15: 64.
16. Cillóniz C, Ewig S, Ferrer M, et al. Community-acquired polymicrobial pneumonia in the intensive care unit: aetiology and prognosis. Crit Care, 2011, 15(5): R209.
17. Finelli L, Fiore A, Dhara R, et al. Influenza-associated pediatric mortality in the United States: increase of Staphylococcus aureus coinfection. Pediatrics, 2008, 122(4): 805-811.
18. McCullers JA. Insights into the interaction between influenza virus and pneumococcus. Clin Microbiol Rev, 2006, 19(3): 571-582.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical characteristics and etiological analysis of community-acquired pneumonia in the elderly aged 80 and over

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